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Sample records for pleural fluid procalcitonin

  1. Pleural fluid culture

    MedlinePlus

    Culture - pleural fluid ... is used to get a sample of pleural fluid. The sample is sent to a laboratory and ... the chest wall into the pleural space. As fluid drains into a collection bottle, you may cough ...

  2. Pleural fluid analysis

    MedlinePlus

    ... of fluid that has collected in the pleural space. This is the space between the lining of the outside of the ... the chest. When fluid collects in the pleural space, the condition is called pleural effusion .

  3. Pleural fluid smear

    MedlinePlus

    ... the fluid that has collected in the pleural space. This is the space between the lining of the outside of the ... the chest. When fluid collects in the pleural space, the condition is called pleural effusion .

  4. Pleural Fluid Analysis Test

    MedlinePlus

    ... limited. Home Visit Global Sites Search Help? Pleural Fluid Analysis Share this page: Was this page helpful? Formal name: Pleural Fluid Analysis Related tests: Pericardial Fluid Analysis , Peritoneal Fluid ...

  5. Pleural fluid Gram stain

    MedlinePlus

    Gram stain of pleural fluid ... lungs fill a person's chest with air. If fluid builds up in the space outside the lungs ... chest, it can cause many problems. Removing the fluid can relieve a person's breathing problems and help ...

  6. Cytology exam of pleural fluid

    MedlinePlus

    ... the lungs. This area is called the pleural space. Cytology means the study of cells. ... A sample of fluid from the pleural space is needed. The sample is taken using a procedure called thoracentesis . The procedure is done in the following way: You sit on a ...

  7. Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

    PubMed Central

    Biswas, Biswajit; Sharma, Sudershan Kumar; Negi, Rameshwar Singh; Gupta, Neelam; Jaswal, Virender Mohan Singh; Niranjan, Narsimhalu

    2016-01-01

    Objective: The present study is designed to evaluate the role of pleural fluid analysis in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. Materials and Methods: We prospectively included 66 consecutive indoor patients over a duration of 1 year. Pleural fluid was collected and cytological smears were made from the fluid. Plural biopsy was done in the same patient by Cope needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2%) cases. Results: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in the younger age group. Majority (70.8%) of malignancy cases were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7%) malignant neoplasm in the pleurae followed by small-cell carcinoma (20.8%). Conclusion: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

  8. Normal volume and cellular contents of pleural fluid.

    PubMed

    Noppen, M

    2001-07-01

    The pleural space in healthy humans was thought to contain a few milliliters of fluid, based on extrapolation from animal studies. However, because of the obvious technical difficulties in atraumatically retrieving such a small volume of fluid, the exact volume and cellular content of human pleural fluid has not been known. Development of a minimally invasive pleural lavage technique has allowed, for the first time, the measurement of volume and cellular content of the pleural fluid in healthy humans. PMID:11470970

  9. Pleural fluids associated with chest infection.

    PubMed

    Quadri, Amal; Thomson, Anne H

    2002-12-01

    Pleural effusions are commonly associated with pneumonias and a small number of these progress to empyema. An understanding of the physiology and pathophysiology of pleural fluid aids the clinician in the management of empyema. There remains much debate about the optimal treatment of empyema in children. Early recognition of the condition is important since delayed therapy may result in unnecessary morbidity. Conventional management with high dose parenteral antibiotics and chest tube drainage remains the mainstay of therapy. However, this treatment modality may fail if the pleural fluid becomes viscous and loculated and, therefore, a more aggressive approach is required. Intrapleural fibrinolytic therapy has been shown to decrease the length of hospital stay and may reduce the need for surgical intervention. The prognosis in children with parapneumonic empyema is excellent with the vast majority retaining normal lung function at long term follow-up.

  10. [Minimally invasive approach in the pleural fluids].

    PubMed

    Sen, Serdar; Sentürk, Ekrem; Pabuşcu, Engin; Cokpinar, Salih; Yaman, Ertan

    2010-01-01

    The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness. PMID:20517732

  11. Identifying Thoracic Malignancies Through Pleural Fluid Biomarkers

    PubMed Central

    Porcel, José M.; Esquerda, Aureli; Martínez-Alonso, Montserrat; Bielsa, Silvia; Salud, Antonieta

    2016-01-01

    Abstract The diagnosis of malignant pleural effusions may be challenging when cytological examination of aspirated pleural fluid is equivocal or noncontributory. The purpose of this study was to identify protein candidate biomarkers differentially expressed in the pleural fluid of patients with mesothelioma, lung adenocarcinoma, lymphoma, and tuberculosis (TB). A multiplex protein biochip comprising 120 biomarkers was used to determine the pleural fluid protein profile of 29 mesotheliomas, 29 lung adenocarcinomas, 12 lymphomas, and 35 tuberculosis. The relative abundance of these predetermined biomarkers among groups served to establish the differential diagnosis of: malignant versus benign (TB) effusions, lung adenocarcinoma versus mesothelioma, and lymphoma versus TB. The selected putative markers were validated using widely available commercial techniques in an independent sample of 102 patients. Significant differences were found in the protein expressions of metalloproteinase-9 (MMP-9), cathepsin-B, C-reactive protein, and chondroitin sulfate between malignant and TB effusions. When integrated into a scoring model, these proteins yielded 85% sensitivity, 100% specificity, and an area under the curve (AUC) of 0.98 for labeling malignancy in the verification sample. For lung adenocarcinoma–mesothelioma discrimination, combining CA19-9, CA15-3, and kallikrein-12 had maximal discriminatory capacity (65% sensitivity, 100% specificity, AUC 0.94); figures which also refer to the validation set. Last, cathepsin-B in isolation was only moderately useful (sensitivity 89%, specificity 62%, AUC 0.75) in separating lymphomatous and TB effusions. However, this last differentiation improved significantly when cathepsin-B was used with respect to the patient's age (sensitivity 72%, specificity 100%, AUC 0.94). In conclusion, panels of 4 (i.e., MMP-9, cathepsin-B, C-reactive protein, chondroitin sulfate), or 3 (i.e., CA19-9, CA15-3, kallikrein-12) different protein

  12. Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

    PubMed Central

    Lee, Jaehee; Lim, Jae Kwang; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Park, Jae Yong

    2016-01-01

    Background Tuberculous pleural effusion (TPE) exhibits different characteristics according to pleural fluid cellular predominance or whether the pleural fluid is free-flowing or loculated. However, its categorization based on either of these factors alone may be insufficient to properly reflect the heterogeneous manifestation of TPE. We evaluated the characteristics of the four TPE groups classified according to cellular predominance and whether the fluid is free-flowing or loculated. Methods A cohort of 375 patients with TPE was retrospectively reviewed. Clinical, radiological, and laboratory findings were compared between neutrophilic and lymphocytic TPE, and between free-flowing and loculated effusion for both neutrophilic and lymphocytic TPE. Results Lymphocytic TPE and neutrophilic TPE were observed in 336 (90%) and 39 (10%) patients, respectively. Pleural fluid loculation was present in 36% and 31% of the patients in the lymphocytic and neutrophilic groups, respectively. A few parameters of the laboratory findings between neutrophilic and lymphocytic TPE patients showed significant differences. However, these significant differences were prominently observed when comparing free-flowing and loculated subgroups of the respective neutrophilic and lymphocytic groups. Pleural fluid pH, lactate dehydrogenase, and adenosine deaminase levels were significantly different among the four subgroups. The neutrophilic loculated subgroup exhibited the most intense pleural inflammation and the highest mycobacterial yields when compared to the other subgroups. However, the percentage of neutrophils in the pleural fluid was not positively associated with the probability of culture-positive effusion. Conclusions The heterogeneous manifestation of TPE would be better characterized by using a classification system based on combined pleural fluid cellular predominance and loculation, with the neutrophilic loculated subgroup contributing to most of the clinically significant

  13. Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

    PubMed Central

    Lee, Jaehee; Lim, Jae Kwang; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Park, Jae Yong

    2016-01-01

    Background Tuberculous pleural effusion (TPE) exhibits different characteristics according to pleural fluid cellular predominance or whether the pleural fluid is free-flowing or loculated. However, its categorization based on either of these factors alone may be insufficient to properly reflect the heterogeneous manifestation of TPE. We evaluated the characteristics of the four TPE groups classified according to cellular predominance and whether the fluid is free-flowing or loculated. Methods A cohort of 375 patients with TPE was retrospectively reviewed. Clinical, radiological, and laboratory findings were compared between neutrophilic and lymphocytic TPE, and between free-flowing and loculated effusion for both neutrophilic and lymphocytic TPE. Results Lymphocytic TPE and neutrophilic TPE were observed in 336 (90%) and 39 (10%) patients, respectively. Pleural fluid loculation was present in 36% and 31% of the patients in the lymphocytic and neutrophilic groups, respectively. A few parameters of the laboratory findings between neutrophilic and lymphocytic TPE patients showed significant differences. However, these significant differences were prominently observed when comparing free-flowing and loculated subgroups of the respective neutrophilic and lymphocytic groups. Pleural fluid pH, lactate dehydrogenase, and adenosine deaminase levels were significantly different among the four subgroups. The neutrophilic loculated subgroup exhibited the most intense pleural inflammation and the highest mycobacterial yields when compared to the other subgroups. However, the percentage of neutrophils in the pleural fluid was not positively associated with the probability of culture-positive effusion. Conclusions The heterogeneous manifestation of TPE would be better characterized by using a classification system based on combined pleural fluid cellular predominance and loculation, with the neutrophilic loculated subgroup contributing to most of the clinically significant

  14. Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions.

    PubMed

    Kim, Chang Ho; Lee, So Yeon; Lee, Yong Dae; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Park, Jae Yong; Lee, Jaehee

    2016-01-01

    Objective Although tuberculous pleural effusion (TPE) is commonly characterized by lymphocytic predominance and high adenosine deaminase (ADA) levels, it may present with neutrophilic predominance or low ADA levels, which are more commonly found in parapneumonic effusion (PPE) or malignant pleural effusion (MPE), respectively. A few studies have observed that the atypical pleural fluid profiles of these cases of TPE may resolve at follow-up thoracentesis. However, these observations were incompletely analyzed and lacked comparison with proper control groups. Thus, limited data are available comparing the sequential pleural fluid changes between TPE and PPE or MPE with similar pleural fluid profiles. Methods TPE, PPE, and MPE patients who underwent sequential thoracentesis were retrospectively reviewed. The sequential changes in the pleural fluid profiles were compared between neutrophilic TPE and PPE, and lymphocytic TPE and MPE with low ADA levels. Results Twenty-three TPE patients (16 with neutrophilic exudates, seven with lymphocytic exudates), 72 cases of PPE with neutrophilic exudates, and 18 cases of MPE with lymphocytic exudates were included in the analysis. A sequential shift to lymphocytic exudates occurred significantly more often in TPE than in PPE cases. The initial and follow-up ADA levels in TPE cases with a lymphocytic shift were significantly higher than those in PPE cases with a lymphocytic shift. The ADA levels in the TPE cases with initial lymphocytic exudates and low ADA levels significantly increased at follow-up thoracentesis. For the TPE and MPE cases with initial lymphocytic exudates and ADA levels <40 U/L, the frequency of effusion with ADA levels ≥40 U/L at the second thoracentesis was significantly higher in the TPE cases. Conclusion Follow-up thoracentesis may provide useful information for clinical decision-making in suspected atypical TPE cases with neutrophilic exudates or low ADA levels. PMID:27374670

  15. Defect in recruiting effector memory CD8+ T-cells in malignant pleural effusions compared to normal pleural fluid

    PubMed Central

    2013-01-01

    Background Malignant pleural effusions (MPE) are a common and fatal complication in cancers including lung or breast cancers, or malignant pleural mesothelioma (MPM). MPE animal models and immunotherapy trials in MPM patients previously suggested defects of the cellular immunity in MPE. However only few observational studies of the immune response were done in MPM patients, using questionable control groups (transudate…). Methods We compared T cell populations evaluated by flow cytometry from blood and pleural effusion of untreated patients with MPM (n = 58), pleural metastasis of adenocarcinoma (n = 30) or with benign pleural lesions associated with asbestos exposure (n = 23). Blood and pleural fluid were also obtained from healthy subjects, providing normal values for T cell populations. Results Blood CD4+ or CD8+ T cells percentages were similar in all groups of patients or healthy subjects. Whereas pleural fluid from healthy controls contained mainly CD8+ T cells, benign or malignant pleural effusions included mainly CD4+ T cells. Effector memory T cells were the main T cell subpopulation in pleural fluid from healthy subjects. In contrast, there was a striking and selective recruitment of central memory CD4+ T cells in MPE, but not of effector cells CD8+ T cells or NK cells in the pleural fluid as one would expect in order to obtain an efficient immune response. Conclusions Comparing for the first time MPE to pleural fluid from healthy subjects, we found a local defect in recruiting effector CD8+ T cells, which may be involved in the escape of tumor cells from immune response. Further studies are needed to characterize which subtypes of effector CD8+ T cells are involved, opening prospects for cell therapy in MPE and MPM. PMID:23816056

  16. Detection of EpCAM-positive microparticles in pleural fluid: A new approach to mini-invasively identify patients with malignant pleural effusions

    PubMed Central

    Roca, Elisa; Lacroix, Romaric; Judicone, Coralie; Laroumagne, Sophie; Robert, Stéphane; Cointe, Sylvie; Muller, Alexandre; Kaspi, Elise; Roll, Patrice; Brisson, Alain R.; Tantucci, Claudio

    2016-01-01

    Pleural biomarkers allowing to mini-invasively discriminate benign from malignant pleural effusions are needed. Among potential candidates, microparticles (MPs) are extracellular vesicles that vectorize antigen derived from the parent cell. We hypothesized that tumor-derived MPs could be present in the pleural liquid and help to identify patients with malignant pleural effusions. Using highly sensitive flow cytometry and cryo-electron microscopy, we showed that large amounts of MPs from hematopoïetic and vascular origin could be detectable in pleural fluids. Their level did not differ between benign (n = 14) and malignant (n = 71) pleural effusions. Analysis of selected tumoral associated antigens (podoplanin, mucin 1 and EpCAM, epithelial-cell-adhesion-molecule) evidenced for the first time the presence of tumor-derived MPs expressing EpCAM in malignant pleural fluids only (Specificity = 93%, Sensitivity = 49% and 45% for flow cytometry and ELISA, respectively). The detection of EpCAM-positive-MPs (EpCAM + MPs) by flow cytometry showed a better specificity and sensitivity than ELISA to distinguish between pleural carcinoma and the others malignant pleural effusions (MPE; Sp: 96% vs 89%; Se: 79% vs 66%). Combining EpCAM+ MPs and cytology improved the diagnosis of MPE compared to cytology alone. This study establishes the basis for using EpCAM+ MPs as a promising new biomarker that could be added to the armamentarium to mini-invasively identify patients with malignant pleural effusions. PMID:26689993

  17. Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis.

    PubMed

    Nepal, A K; Gyawali, N; Poudel, B; Mahato, R V; Lamsal, M; Gurung, R; Baral, N; Majhi, S

    2012-12-01

    Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis. PMID:24579533

  18. Dynamic and Volumetric Variables Reliably Predict Fluid Responsiveness in a Porcine Model with Pleural Effusion

    PubMed Central

    Broch, Ole; Gruenewald, Matthias; Renner, Jochen; Meybohm, Patrick; Schöttler, Jan; Heß, Katharina; Steinfath, Markus; Bein, Berthold

    2013-01-01

    Background The ability of stroke volume variation (SVV), pulse pressure variation (PPV) and global end-diastolic volume (GEDV) for prediction of fluid responsiveness in presence of pleural effusion is unknown. The aim of the present study was to challenge the ability of SVV, PPV and GEDV to predict fluid responsiveness in a porcine model with pleural effusions. Methods Pigs were studied at baseline and after fluid loading with 8 ml kg−1 6% hydroxyethyl starch. After withdrawal of 8 ml kg−1 blood and induction of pleural effusion up to 50 ml kg−1 on either side, measurements at baseline and after fluid loading were repeated. Cardiac output, stroke volume, central venous pressure (CVP) and pulmonary occlusion pressure (PAOP) were obtained by pulmonary thermodilution, whereas GEDV was determined by transpulmonary thermodilution. SVV and PPV were monitored continuously by pulse contour analysis. Results Pleural effusion was associated with significant changes in lung compliance, peak airway pressure and stroke volume in both responders and non-responders. At baseline, SVV, PPV and GEDV reliably predicted fluid responsiveness (area under the curve 0.85 (p<0.001), 0.88 (p<0.001), 0.77 (p = 0.007). After induction of pleural effusion the ability of SVV, PPV and GEDV to predict fluid responsiveness was well preserved and also PAOP was predictive. Threshold values for SVV and PPV increased in presence of pleural effusion. Conclusions In this porcine model, bilateral pleural effusion did not affect the ability of SVV, PPV and GEDV to predict fluid responsiveness. PMID:23418546

  19. What is your diagnosis? Pleural fluid from a neonatal Thoroughbred filly with pneumonia.

    PubMed

    Stokol, Tracy; Gold, Jenifer; Johnson, Amy; Ainsworth, Dorothy

    2008-06-01

    A 3-day-old filly was presented to the Cornell University Hospital for Animals with an umbilical hematoma and mild aspiration pneumonia. The foal underwent abdominal surgery for resection of the hematoma. Recovery was uneventful, but 3 days after surgery, the foal became progressively tachypneic. Imaging studies revealed bilateral pleural effusion and pleuropneumonia. Cytologic evaluation and bacterial culture of the pleural fluid from both sides of the chest revealed sterile exudates, consisting mostly of neutrophils, with fewer macrophages and lymphocytes. Pleural fluid macrophages contained variable amounts of purple-magenta globular material in their cytoplasm. A lighter colored granular precipitate was also seen throughout the background of the smears. Similar material was identified in a macrophage in a peripheral blood smear prepared 2 days after abdominal surgery. Large amounts of extracellular pink precipitate were also seen in the blood smear and persisted in the blood for 7 days after surgery. A protective lubricant, carboxymethylcellulose, had been instilled into the abdominal cavity during surgery to prevent intra-abdominal adhesions. The intracytoplasmic pigment within pleural fluid and blood macrophages and the extracellular precipitate in peripheral blood and pleural fluid smears was compatible with carboxymethylcellulose. The material was probably derived hematogenously and was considered an incidental finding. The pleuritis was attributed to exacerbation of the original aspiration pneumonia by the general anesthesia. PMID:18533926

  20. Pleural effusion

    MedlinePlus

    ... Chest CT scan Chest x-ray Kidney and liver function blood tests Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, cancer cells, and protein level) Thoracentesis (a sample of fluid ...

  1. Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation*

    PubMed Central

    de Camargo, Priscila Cilene León Bueno; Afonso, José Eduardo; Samano, Marcos Naoyuki; Acencio, Milena Marques Pagliarelli; Antonangelo, Leila; Teixeira, Ricardo Henrique de Oliveira Braga

    2014-01-01

    Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients. PMID:25210966

  2. An improved technique for studying pleural fluid pressure and composition in rabbits.

    PubMed

    Del Fabbro, M

    1998-07-01

    Knowledge of pleural liquid pressure (Pliq) and composition is crucial for studies concerning intrapleural fluid dynamics, and pleural fluid turnover. We measured Pliq at intercostal and costal levels in anaesthetized spontaneously breathing rabbits using a minimally invasive method that assures a long-lasting hydraulic continuity between the pleural liquid and the recording system. Polyethylene tubes were glued either to the exposed endothoracic fascia or inserted into a rib to provide a scaled connection to the recording system. After inducing a pneumothorax with nitrous oxide (N2O) via an intrapleural cannula, a hole (approximately 0.7 mm2) was pierced in the parietal pleura through the tube lumen. The tubes were then connected to pressure transducers and the whole system was filled with heparinized saline to the level of the parietal pleura; finally the pneumo-thorax was removed after N2O washout and Pliq recordings were performed. A different kind of tube was used to obtain microsamples of pleural fluid (2.5-3 microliters) during spontaneous breathing; colloid osmotic pressure of the microsamples (pi liq) was measured with an osmometer, and averaged 9.3 +/- 1.5 cm H2o (n = 70 samples). When pooled and plotted against lung height end-expiratory intercostal and costal Pliq data scattered along a single regression line with a slope of -0.83 and -0.90 cm H2O cm(-1) in supine and prone animals, respectively. End-inspiratory costal Pliq was significantly more subatmospheric than intercostal in the ventral region of the chest (P < 0.05), and less subatmospheric in the dorsal region, regardless of posture. The techniques presented here could be helpful in gaining a greater insight into the physiology and pathophysiology of the pleural space in terms of pleural fluid dynamics and turnover.

  3. The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions.

    PubMed

    Izhakian, Shimon; Wasser, Walter G; Fox, Benjamin D; Vainshelboim, Baruch; Kramer, Mordechai R

    2016-01-01

    Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups (p < 0.001) with the following means: parapneumonic effusion, 5.38 ± 4.85 mg/dL; lung transplant, 2.77 ± 2.66 mg/dL; malignancy, 1.19 ± 1.51 mg/dL; and heart failure, 0.57 ± 0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37-1.89). Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology.

  4. The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions

    PubMed Central

    Izhakian, Shimon; Wasser, Walter G.; Fox, Benjamin D.; Vainshelboim, Baruch; Kramer, Mordechai R.

    2016-01-01

    Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups (p < 0.001) with the following means: parapneumonic effusion, 5.38 ± 4.85 mg/dL; lung transplant, 2.77 ± 2.66 mg/dL; malignancy, 1.19 ± 1.51 mg/dL; and heart failure, 0.57 ± 0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37–1.89). Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology. PMID:27194820

  5. Molecular detection of free cancer cells in pleural lavage fluid from esophageal cancer patients.

    PubMed

    Natsugoe, Shoji; Tokuda, Koki; Matsumoto, Masataka; Okumura, Hiroshi; Nakajo, Akihiro; Takatori, Hiroyuki; Nakashima, Hiroshi; Ishigami, Sumiya; Takao, Sonshin; Aikou, Takashi

    2003-11-01

    The clinical significance of free cancer cells in pleural lavage fluid detected by molecular methods during surgery remains uncertain in esophageal squamous cell cancer (ESCC). We therefore evaluated the relationship between free cancer cells and clinicopathological findings, and compared the reverse transcriptase-polymerase chain reaction (RT-PCR) method with conventional cytological examination. Pleural lavage fluid from 38 consecutive patients was obtained at two time points; immediately after thoracotomy and before thorax closure. Papanicolaou and Giemsa staining as well as carcinoembryonic antigen (CEA)-specific RT-PCR were performed. The positivity rates obtained using cytological examination and CEA-mRNA expression were 5.3 and 15.8%, respectively. Positive results were observed in pleural lavage fluid after tumor resection. No significant differences in clinicopathologic factors were seen, irrespective of CEA-mRNA expression status. Among the 5 patients exhibiting CEA-mRNA positivity, 2 experienced hematogenous recurrence, 2 experienced mixed recurrence and 1 experienced pleural dissemination. With regard to mode of recurrence and mean period between surgery and relapse, no significant differences were seen between CEA-mRNA-positive and CEA-mRNA-negative patients. Although disease recurred in almost all patients exhibiting CEA-mRNA expression, due to the relatively small sample in the present study the clinical significance must be investigated further in a larger number of patients.

  6. Pleural fluid metastases of myoepithelial carcinoma: A case report and review of the literature

    PubMed Central

    Bhambra, Alicia Calderon; Zhang, Yanhong; Huang, Eric C.; Bishop, John; Matin, Mahan; Afify, Alaa

    2016-01-01

    Myoepithelial carcinoma (MECA) is one of the rarest salivary gland neoplasms, which may either arise de novo or develop within a preexisting pleomorphic adenoma or benign myoepithelioma. The tumor occurs mainly in the parotid gland followed by minor salivary glands and other body sites. As a result of their morphologic heterogeneity, they can be confused easily with many tumors. Awareness of their unique cytoarchitectural patterns and immunohistochemical profile is crucial for accurate identification. Herein, we report a rare case of a 51-year-old female patient with MECA of the maxillary sinus that metastasized to the pleural fluid. To the best of our knowledge, this is the first case of pleural fluid involvement by MECA reported in the literature. PMID:27382407

  7. Pleural fluid metastases of myoepithelial carcinoma: A case report and review of the literature.

    PubMed

    Bhambra, Alicia Calderon; Zhang, Yanhong; Huang, Eric C; Bishop, John; Matin, Mahan; Afify, Alaa

    2016-01-01

    Myoepithelial carcinoma (MECA) is one of the rarest salivary gland neoplasms, which may either arise de novo or develop within a preexisting pleomorphic adenoma or benign myoepithelioma. The tumor occurs mainly in the parotid gland followed by minor salivary glands and other body sites. As a result of their morphologic heterogeneity, they can be confused easily with many tumors. Awareness of their unique cytoarchitectural patterns and immunohistochemical profile is crucial for accurate identification. Herein, we report a rare case of a 51-year-old female patient with MECA of the maxillary sinus that metastasized to the pleural fluid. To the best of our knowledge, this is the first case of pleural fluid involvement by MECA reported in the literature.

  8. TTF-1 and napsin A on cell blocks and supernatants of pleural fluids for labeling malignant effusions.

    PubMed

    Porcel, José M; Palma, Rosa; Bielsa, Silvia; Esquerda, Aureli; Gatius, Sonia; Matias-Guiu, Xavier; Salud, Antonieta

    2015-07-01

    In this retrospective study of 80 pleural effusions, the combination of thyroid transcription factor 1 (TTF-1) and napsin A immunostaining on fluid cell blocks was positive in 80% of lung adenocarcinomas. Although measuring TTF-1 pleural fluid concentrations was of no value, quantification of napsin A levels allowed the identification of one third of the double-negative stained lung adenocarcinomas, with an overall accuracy similar to classical tumour markers for malignant-benign discrimination (sensitivity 40%, specificity 100%).

  9. Pleural Disorders

    MedlinePlus

    ... chest is the most common cause of hemothorax. Treatment focuses on removing fluid, air, or blood from the pleural space, relieving symptoms, and treating the underlying condition. NIH: National Heart, Lung, and Blood Institute

  10. Identifying Thoracic Malignancies Through Pleural Fluid Biomarkers: A Predictive Multivariate Model.

    PubMed

    Porcel, José M; Esquerda, Aureli; Martínez-Alonso, Montserrat; Bielsa, Silvia; Salud, Antonieta

    2016-03-01

    The diagnosis of malignant pleural effusions may be challenging when cytological examination of aspirated pleural fluid is equivocal or noncontributory. The purpose of this study was to identify protein candidate biomarkers differentially expressed in the pleural fluid of patients with mesothelioma, lung adenocarcinoma, lymphoma, and tuberculosis (TB).A multiplex protein biochip comprising 120 biomarkers was used to determine the pleural fluid protein profile of 29 mesotheliomas, 29 lung adenocarcinomas, 12 lymphomas, and 35 tuberculosis. The relative abundance of these predetermined biomarkers among groups served to establish the differential diagnosis of: malignant versus benign (TB) effusions, lung adenocarcinoma versus mesothelioma, and lymphoma versus TB. The selected putative markers were validated using widely available commercial techniques in an independent sample of 102 patients.Significant differences were found in the protein expressions of metalloproteinase-9 (MMP-9), cathepsin-B, C-reactive protein, and chondroitin sulfate between malignant and TB effusions. When integrated into a scoring model, these proteins yielded 85% sensitivity, 100% specificity, and an area under the curve (AUC) of 0.98 for labeling malignancy in the verification sample. For lung adenocarcinoma-mesothelioma discrimination, combining CA19-9, CA15-3, and kallikrein-12 had maximal discriminatory capacity (65% sensitivity, 100% specificity, AUC 0.94); figures which also refer to the validation set. Last, cathepsin-B in isolation was only moderately useful (sensitivity 89%, specificity 62%, AUC 0.75) in separating lymphomatous and TB effusions. However, this last differentiation improved significantly when cathepsin-B was used with respect to the patient's age (sensitivity 72%, specificity 100%, AUC 0.94).In conclusion, panels of 4 (i.e., MMP-9, cathepsin-B, C-reactive protein, chondroitin sulfate), or 3 (i.e., CA19-9, CA15-3, kallikrein-12) different protein biomarkers on pleural

  11. Role of pulmonary lymphatics and interstitium in visceral pleural fluid exchange.

    PubMed

    Kinasewitz, G T; Groome, L J; Marshall, R P; Diana, J N

    1984-02-01

    If the pulmonary lymphatics and/or interstitium of the lung participate in visceral pleural (VP) fluid exchange, then increasing the water content of the interstitial compartment by lymphatic ligation (L) should increase the filtration and/or decrease the absorption of fluid across the VP membrane. To test this hypothesis, the hydraulic conductivity (Lp) and diffusional permeability for protein (Pd) of the visceral pleura were determined in eight spontaneously breathing anesthetized chronic L dogs and seven sham-operated (S) controls. The left lung was enclosed in a water-impermeable membrane, creating a VP space; fluid flux was determined as the filtration or reabsorption of water and protein in the VP space. Intravascular and pleural pressures and the protein concentration of plasma and pleural fluid were monitored during two or more experimental periods in which different mixtures of plasma and saline were introduced in the VP space. At similar pulmonary capillary pressures, the extravascular lung water of the L animals [5.36 (+/- 0.32) g/g dry blood-free lung] was significantly (P less than 0.001) greater than that of the S dogs [3.79 (+/- 0.13)]. The Lp of the L dogs [6.8 (+/- 1.6) X 10(-7) ml X s-1 X cm-2 X Torr-1] was virtually identical (P greater than 0.8) to the 6.7 (+/- 1.4) ml X s-1 X cm-2 X Torr-1 of the S controls. Similarly, Pd in the L group [4.3 (+/- 0.5) X 10(-6) cm/s] was similar (P greater than 0.5) to that of the S animals [5.1 (+/- 1.1) X 10(-6) cm/s]. We conclude that neither the pulmonary lymphatics nor the interstitium of the lung contribute to VP fluid exchange.

  12. Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT).

    PubMed

    Hyodoh, Hideki; Shimizu, Jyunya; Watanabe, Satoshi; Okazaki, Shunichiro; Mizuo, Keisuke; Inoue, Hiromasa

    2015-07-01

    Postmortem CT (PMCT) is increasingly used in forensic practice, and knowledge and classification of typical postmortem imaging findings would facilitate the interpretation of PMCT. The goal of this study was to define the time-related course of postmortem chest findings. Twelve cadavers (eight male, four female, 27-81 [mean, 60.0]years) were examined twice by PMCT within an interval of time (4-164 h [mean, 30.8; median, 17.5]). The pleural-space-fluid volume, pulmonary parenchyma volume, decreased aerated lung volume (DLV), %DLV (=DLV/pulmonary parenchyma volume) and chest cavity volume were compared between the first and second PMCT examinations. To evaluate the volume change rate, the rate of increase in pleural space fluid volume (mL/h) and the DLV rate (mL/h) were plotted according to the postmortem period. On the second PMCT, the volume of pleural space fluid (p=0.0469) and %DLV (p=0.0161) were significantly increased. The increase rate of the pleural space fluid increased at approximately 30 h and the volume continued to increase until approximately 40 h after death. The rate of DLV constantly decreased in the early postmortem period. In conclusion, the pleural-space-fluid collection and the DLV increased over different time-related courses in the postmortem period.

  13. Recovery of microorganisms from synovial and pleural fluids of animals using hyperosmolar media.

    PubMed

    Buchanan, A M; Davis, D C; Pedersen, N C; Beaman, B L

    1982-03-01

    L-phase (CWD) broth and plate media were used in parallel with conventional microbiological media during a 3-year period for culturing synovial and pleural fluids of animals. Two kinds of recoveries were obtained where parallel conventional methods were negative: (1) parent or normal bacteria, in very low numbers; and (2) Type B CWD variants in equally low numbers. Organisms in group 1 were: Streptococcus zooepidemicus from horses (2x); beta-hemolytic streptococci, Lancefield Gp. G (2x); Staphylococcus aureus; Actinobacillus, and Actinomyces viscosus. Group 2 consisted of Bacteroides sp., Propionibacterium acnes, and three "Nocardia-like" sp. Catalase + Actinomyces was not recovered equally well on CWD plates as on conventional media with fluids obtained during ampicillin treatment. This occurred in spite of the fact that the CWD media was shown to support growth and reversion of laboratory induced L-phase variants of Nocardia caviae and N. asteroides, and had facilitated recovery of a Bacteroides L-phase variant from a pleural fluid. The nature of this fault in the media is under investigation in this laboratory. PMID:7101719

  14. Partial pressures of oxygen and carbon dioxide, pH, and concentrations of bicarbonate, lactate, and glucose in pleural fluid from horses.

    PubMed

    Brumbaugh, G W; Benson, P A

    1990-07-01

    Samples of pleural fluid from 20 horses with effusive pleural diseases of various causes were evaluated; samples from 19 horses were used for the study. There were differences for pH (P = 0.001) and partial pressure of oxygen (PO2) between arterial blood and nonseptic pleural fluid (P = 0.0491), but there were no differences for pH, PO2, partial pressure of carbon dioxide (PCO2), and concentrations of bicarbonate (HCO3-), lactate, and glucose between venous blood and nonseptic pleural fluid. Paired comparisons of venous blood and nonseptic pleural fluid from the same horse indicated no differences. There were differences (P = 0.0001, each) for pH, PO2, PCO2, and concentrations of HCO3- between arterial blood and septic pleural fluid. Differences also existed for pH (P = 0.0001), PCO2 (P = 0.0003), and concentrations of HCO3- (P = 0.0001), lactate (P = 0.0051), and glucose (P = 0.0001) between venous blood and septic pleural fluid. Difference was not found for values of PO2 between venous blood and septic pleural fluid, although 4 samples of septic pleural fluid contained virtually no oxygen. Paired comparisons of venous blood and septic pleural fluid from the same horse revealed differences (P less than 0.05) for all values, except those for PO2. These alterations suggested functional and physical compartmentalization that separated septic and healthy tissue. Compartmentalization and microenvironmental factors at the site of infection should be considered when developing therapeutic strategies for horses with septic pleural disease. PMID:2389879

  15. Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology

    PubMed Central

    Shivakumarswamy, Udasimath; Arakeri, Surekha U; Karigowdar, Mahesh H; Yelikar, BR

    2012-01-01

    Background: The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered as a definitive diagnosis. It helps in staging, prognosis and management of the patients in malignancies and also gives information about various inflammatory and non-inflammatory lesions. Diagnostic problems arise in everyday practice to differentiate reactive atypical mesothelial cells and malignant cells by the routine conventional smear (CS) method. Aims: To compare the morphological features of the CS method with those of the cell block (CB) method and also to assess the utility and sensitivity of the CB method in the cytodiagnosis of pleural effusions. Materials and Methods: The study was conducted in the cytology section of the Department of Pathology. Sixty pleural fluid samples were subjected to diagnostic evaluation for over a period of 20 months. Along with the conventional smears, cell blocks were prepared by using 10% alcohol–formalin as a fixative agent. Statistical analysis with the ‘z test’ was performed to identify the cellularity, using the CS and CB methods. Mc. Naemer's χ2test was used to identify the additional yield for malignancy by the CB method. Results: Cellularity and additional yield for malignancy was 15% more by the CB method. Conclusions: The CB method provides high cellularity, better architectural patterns, morphological features and an additional yield of malignant cells, and thereby, increases the sensitivity of the cytodiagnosis when compared with the CS method. PMID:22438610

  16. Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

    PubMed Central

    Miédougé, M; Rouzaud, P; Salama, G; Pujazon, M-C; Vincent, C; Mauduyt, M-A; Reyre, J; Carles, P; Serre, G

    1999-01-01

    Carcinoembryonic antigen (CEA), carbohydrate antigens 15–3, 19–9 and 72–4 (CA 15–3, CA 19–9 and CA 72–4), cytokeratin 19 fragments (CYFRA 21–1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15–3 and CA 72–4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15–3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15–3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15–3, CYFRA 21–1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions. © 1999 Cancer Research Campaign PMID:10576665

  17. Pleural malignancies.

    PubMed

    Vargas, F S; Teixeira, L R

    1996-07-01

    Carcinoma of the lung, metastatic breast carcinoma, and lymphoma are responsible for approximately 75% of all malignant pleural effusions. The presence of malignant cells in the pleural fluid or in the parietal pleura confirms the diagnosis. Recently, several authors have proposed the combination of morphometric procedures and quantitative analysis of nucleolar organizer regions stained by silver nitrate. Videothoracoscopy is recommended for patients suspected of having a malignant pleural effusion in whom the diagnosis is not established after two cytologic studies of the fluid and one needle biopsy. The standard treatment is the intrapleural instillation of a chemical agent to produce a pleurodesis. The recommended sclerosant is talc, a tetracycline derivative, or Corynebacterium parvum where it is available. When a patient is not an ideal candidate for chemical pleurodesis, the options include symptomatic treatment, serial thoracentesis, implantation of a pleuroperitoneal shunt, and pleurectomy. PMID:9363162

  18. Diagnostic Tools of Pleural Effusion

    PubMed Central

    2014-01-01

    Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references. PMID:24920946

  19. Single-strand conformational polymorphism (SSCP)-detected p53 gene mutations are a less sensitive marker of malignancy in pleural fluids than p53 immunostaining.

    PubMed

    Mayall, F; Cursons, R; Jacobson, G; Chang, B

    1999-08-01

    p53 immunostaining has been advocated as a marker of malignancy in pleural biopsies and serous fluids. The object of this study was to compare the sensitivity and specificity of p53 immunostaining for the detection of malignant cells in pleural fluids with a technique designed to detect p53 gene mutations in exons 5, 6, 7 and 8 by SSCP and nucleotide sequencing. Five out of eight pleural fluids containing adenocarcinoma showed p53 immunostaining and two of these also showed polymorphisms on SSCP and a mutation on sequencing. None of the 10 benign pleural fluids showed immunostaining for p53 or polymorphisms on SSCP. We believe that the poor sensitivity of p53 gene mutation by SSCP is mainly due to DNA from the background reactive cells 'swamping' the mutant DNA. We do not advocate its use as a diagnostic aid.

  20. Reflex Testing Rules for Cell Count and Differentiation of Nucleated Elements in Pleural and Ascitic Fluids on Sysmex XE-5000.

    PubMed

    Buoro, Sabrina; Appassiti Esposito, Sara; Vavassori, Mauro; Mecca, Tommaso; Ottomano, Cosimo; Dominoni, Paola; Seghezzi, Michela; Candiago, Elisabetta; Farina, Claudio; Gianatti, Andrea; Crippa, Alberto; Lippi, Giuseppe

    2016-04-01

    Flow cytometry is widely used in many laboratories for automated nucleated cell counts and their differentiation in body fluids. The implementation of new reflex testing rules on these automated instruments could open new frontiers in laboratory workflow, improving characterization of body fluids and clinical diagnosis and decreasing costs. Ascitic (150) and pleural (33) fluids were collected and assessed by XE-5000 and optical microscopy. Cell counts performed with the methods showed a Pearson's correlation of 0.98 (p < 0.0001), Passing-Bablok regression y = 0.99x + 2.44, and bias of 32.3. In ascitic fluids, the best diagnostic performance was found for polymorphonuclear and neutrophil counts on XE-5000, which exhibited areas under the curve (AUCs) 0.98 (p < 0.0001) and 0.99 (p < 0.0001), respectively. In pleural fluids the best diagnostic performance was found for polymorphonuclear percent parameter, which displayed 0.97 (p < 0.0001). Specific reflex test rules based on these parameters were characterized by 92% diagnostic concordance, 1.00 sensitivity, and 0.84 specificity with optical microscopy. The application of a set of reflex testing rules may improve the diagnostic performance of XE-5000, increasing its reliability for routine automated cell count in body fluids. We acknowledge that further studies should be planned to validate our findings according to clinical data.

  1. Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis.

    PubMed

    Wang, Chenggong; Zhong, DA; Liao, Qiande; Kong, Lingyu; Liu, Ansong; Xiao, Han

    2014-10-01

    Whether the levels of procalcitonin (PCT) in the serum and synovial fluid are effective indicators for distinguishing septic arthritis (SA) from non-infectious arthritis remains controversial. The present study aimed to evaluate whether PCT levels in fresh serum or fresh joint fluid may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), osteoarthritis (OA) and gouty arthritis (GA). From January 2012 to June 2013, 23 patients with knee SA, 21 patients with RA, 40 patients with OA and 11 patients with GA were enrolled in the current study. The levels of PCT were measured within 24 h after specimen collection at room temperature. An enzyme-linked fluorescence assay (ELFA) was used to detect the levels of PCT in the serum and synovial fluid. The correlations between the levels of PCT in the serum and synovial fluid and the arthritic patient groups were determined by the Nemenyi test. Areas under the receiver operating characteristic (ROC) curve were calculated to evaluate the accuracy of the correlations. The levels of PCT in the serum and joint fluid of the patients in the SA group were higher compared with those of the other groups (P<0.01) and there were no significant differences among the RA, OA and GA groups in these levels. A PCT level of <0.5 μg/l in the serum and synovial fluid had high specificity in the differential diagnosis of SA from RA, OA and GA. Synovial fluid PCT revealed significantly greater sensitivity than serum PCT. The accuracy of the differential diagnosis of SA by the serum levels of PCT was significantly lower than that by the synovial fluid levels of PCT. The levels of PCT in the serum and synovial fluid may be used as alternative laboratory indicators to distinguish between SA and the non-infectious types of arthritis; however, the PCT levels in fresh synovial fluid are more sensitive and accurate indicators than PCT levels in fresh serum.

  2. [Management of parapneumonic pleural effusions].

    PubMed

    Asensio de la Cruz, O; Blanco González, J; Moreno Galdó, A; Pérez Frías, J; Salcedo Posadas, A; Sanz Borrell, L

    2001-03-01

    Pleural effusion in children is most often due to bacterial pneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40% of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism. Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100%, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100% of patients, also depending on the effusion stage.

  3. Tuberculous pleural effusion

    PubMed Central

    Zhai, Kan; Lu, Yong

    2016-01-01

    Although it is curable, tuberculosis remains one of the most frequent causes of pleural effusions on a global scale, especially in developing countries. Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. TPE usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. The gold standard for the diagnosis of TPE remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli, Although adenosine deaminase and interferon-γ in pleural fluid have been documented to be useful tests for the diagnosis of TPE. It can be accepted that in areas with high tuberculosis prevalence, the easiest way to establish the diagnosis of TPE in a patient with a lymphocytic pleural effusion is to generally demonstrate a adenosine deaminase level above 40 U/L. The recommended treatment for TPE is a regimen with isoniazid, rifampin, and pyrazinamide for two months followed by four months of two drugs, isoniazid and rifampin. PMID:27499981

  4. Tuberculous pleural effusion.

    PubMed

    Zhai, Kan; Lu, Yong; Shi, Huan-Zhong

    2016-07-01

    Although it is curable, tuberculosis remains one of the most frequent causes of pleural effusions on a global scale, especially in developing countries. Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. TPE usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. The gold standard for the diagnosis of TPE remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli, Although adenosine deaminase and interferon-γ in pleural fluid have been documented to be useful tests for the diagnosis of TPE. It can be accepted that in areas with high tuberculosis prevalence, the easiest way to establish the diagnosis of TPE in a patient with a lymphocytic pleural effusion is to generally demonstrate a adenosine deaminase level above 40 U/L. The recommended treatment for TPE is a regimen with isoniazid, rifampin, and pyrazinamide for two months followed by four months of two drugs, isoniazid and rifampin. PMID:27499981

  5. How Are Pleurisy and Other Pleural Disorders Diagnosed?

    MedlinePlus

    ... a pleural effusion, fluid buildup in the pleural space will prevent a friction rub. But if you ... buildup of air or gas in the pleural space). Diagnostic Tests Depending on the results of your ...

  6. [Proper usage of procalcitonin].

    PubMed

    Green, Y; Petignat, P-A; Perrier, A

    2007-10-17

    In the last fifteen years, procalcitonin measurement has been evaluated as a rapid diagnostic aid for suspected infection. Procalcitonin is now widely used in any febrile patient despite the lack of evidence supporting that practice. Indeed, procalcitonine has proven effective in the intensive care setting, as a diagnostic aid for septic shock, as a prognostic instrument and to tailor the duration of antibiotic treatment. Studies in non intensive care settings are more recent and scarce. Procalcitonin has been assessed in the emergency department in patients with lower respiratory tract infections and in patients admitted for an acute febrile illness. Results are encouraging but preliminary, therefore procalcitonine measurement should be restricted to patients with criteria of severe infection for the time being. PMID:18018823

  7. Diagnostic value of mesothelin in pleural fluids: comparison with CYFRA 21-1 and CEA.

    PubMed

    Filiberti, Rosa; Parodi, Stefano; Libener, Roberta; Ivaldi, Giovanni Paolo; Canessa, Pier Aldo; Ugolini, Donatella; Bobbio, Barbara; Marroni, Paola

    2013-06-01

    CYFRA 21-1 and CEA have been applied for the differential diagnosis of malignant pleural mesothelioma (MPM). The soluble mesothelin-related peptide (SMRP) has been proposed as a specific marker for distinguishing MPM from benign diseases and other malignancies in pleural effusions (PEs). In this study, we evaluated the usefulness of SMRP in PEs in the detection of mesotheliomas by comparing it with that of CYFRA 21-1, CEA, and with cytological examination. One hundred and seventy-seven consecutive patients (57 MPM, 64 metastatic tumors, and 56 benign diseases) were evaluated using commercial tests. The performance of the markers was analyzed by standard ROC analysis methods, using the area under a ROC curve (AUC) as a measure of accuracy. CYFRA 21-1 better differentiated malignant from benign effusions. The corresponding area under the receiver operating characteristic curve was 0.87, while it was 0.74 for SMRP and 0.64 for CEA (p < 0.001). Conversely, SMRP differentiated MPM from all other PEs better than both CYFRA 21-1 and CEA (AUC = 0.84, 0.76, and 0.32, respectively, p = 0.003). Low levels of CEA were associated with a MPM diagnosis. The AUC for differentiating MPM from metastases was 0.81 for SMRP, 0.61 for CYFRA 21-1, and 0.20 for CEA (p < 0.001). In cases with negative or suspicious cytology, SMRP and CYFRA 21-1 identified 36/71 and 46/66 malignant PEs (29 and 31 MPM, respectively). Only 1 MPM showed a high CEA concentration. No single marker showed the best performance in any comparison. Results suggest that SMRP could improve CYFRA 21-1 and CEA accuracy in the differential diagnosis of MPM.

  8. Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma.

    PubMed

    DeLapp, David; Chan, Christopher; Nystrom, Perry

    2016-01-01

    Mesothelioma is a rare pulmonary malignancy commonly associated with asbestos exposure. Its presentation is insidious and non-specific, with complaints of chest pain, dyspnea and cough. Chest X-ray may demonstrate unilateral pleural effusion. CT and PET scans may highlight nodular pleural plaques. Diagnosis often times is difficult with negative imaging and negative pleural fluid studies. In rare cases, hydropneumothoraces may be seen. We report a case of malignant pleural mesothelioma presenting as recurrent hydropneumothorax with negative CT scan of the chest for pleural abnormalities and negative pleural fluid studies. PMID:27489758

  9. Pleural protein concentration and liquid volume in spontaneously hypertensive rats.

    PubMed

    Lai-Fook, S J; Kaplowitz, M R

    1988-01-01

    To determine the effect of systemic vascular hypertension on fluid balance in the pleural space, we studied the spontaneously hypertensive rat (SHR) and its genetic normotensive control, the Wistar-Kyoto rat (WKY). We measured arterial and venous pressures, total protein and albumin concentrations of pleural liquid and plasma, pleural space thickness, and pleural surface pressure in SHR and WKY that were matched for weight (260-300 g). Protein concentration was measured by a manual Biuret test and albumin concentration was measured by the bromcresol green colorimetric method. Pleural liquid thickness was measured in situ using light microscopy. Pleural surface pressure was assumed to equal pleural liquid pressure. In the SHR, total protein and albumin concentrations in pleural liquid were lower than in WKY, and pleural space thickness was larger in SHR than in WKY. These results are consistent with a higher capillary pressure and greater fluid filtration in SHR.

  10. Fibronectin in exudative pleural effusions.

    PubMed Central

    Klockars, M; Pettersson, T; Vartio, T; Riska, H; Vaheri, A

    1982-01-01

    Fibronectin is a glycoprotein found in body fluids, loose connective tissue matrix and in basement membranes. Fibronectin in pleural effusion was found to be immunologically indistinguishable from the plasma form, as shown by double-diffusion analysis. Fibronectin isolated from pleural fluid by affinity chromatography on gelatin-Sepharose had a polypeptide pattern similar to that of plasma fibronectin in SDS-polyacrylamide gel electrophoresis. In 28 patients with infectious or non-specific pleural effusion fibronectin concentrations in pleural fluid were 335 +/- 104 micrograms/ml (mean +/- SD), in 15 patients with malignant disease the concentrations were 369 +/- 173 micrograms/ml and in 26 patients with tuberculosis 441 +/- 103 micrograms/ml. The highest concentrations, 605 +/- 252 micrograms/ml, of fibronectin in pleural fluid were detected in 14 patients with connective tissue diseases. The results suggest that increased fibronectin concentrations reflect the presence of a pleurisy due to connective tissue disease or tuberculosis rather than other infectious or malignant disease. Images PMID:7096593

  11. How Are Pleurisy and Other Pleural Disorders Treated?

    MedlinePlus

    ... doctor may use a chest tube to deliver medicines called fibrinolytics to the pleural space. If the fluid still won't drain, you ... build up again after it's drained. Sometimes antitumor medicines will ... the pleural space. Sealing the pleural space is called pleurodesis (plur- ...

  12. Pleural effusion following ovarian hyperstimulation.

    PubMed

    Junqueira, Jader Joel Machado; Bammann, Ricardo Helbert; Terra, Ricardo Mingarini; Castro, Ana Cristina P; Ishy, Augusto; Fernandez, Angelo

    2012-01-01

    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

  13. Activation of calpain by renin-angiotensin system in pleural mesothelial cells mediates tuberculous pleural fibrosis

    PubMed Central

    Yang, Jie; Xiang, Fei; Cai, Peng-Cheng; Lu, Yu-Zhi; Xu, Xiao-Xiao; Yu, Fan; Li, Feng-Zhi; Greer, Peter A.; Shi, Huan-Zhong; Zhou, Qiong; Xin, Jian-Bao; Ye, Hong; Su, Yunchao

    2016-01-01

    Pleural fibrosis is defined as an excessive deposition of extracellular matrix (ECM) components that results in destruction of the normal pleural tissue architecture. It can result from diverse inflammatory conditions, especially tuberculous pleurisy. Pleural mesothelial cells (PMCs) play a pivotal role in pleural fibrosis. Calpain is a family of calcium-dependent endopeptidases, which plays an important role in ECM remodeling. However, the role of calpain in pleural fibrosis remains unknown. In the present study, we found that tuberculous pleural effusion (TPE) induced calpain activation in PMCs and that inhibition of calpain prevented TPE-induced collagen-I synthesis and cell proliferation of PMCs. Moreover, our data revealed that the levels of angiotensin (ANG)-converting enzyme (ACE) were significantly higher in pleural fluid of patients with TPE than those with malignant pleural effusion, and ACE-ANG II in TPE resulted in activation of calpain and subsequent triggering of the phosphatidylinositol 3-kinase (PI3K)/Akt/NF-κB signaling pathway in PMCs. Finally, calpain activation in PMCs and collagen depositions were confirmed in pleural biopsy specimens from patients with tuberculous pleurisy. Together, these studies demonstrated that calpain is activated by renin-angiotensin system in pleural fibrosis and mediates TPE-induced collagen-I synthesis and proliferation of PMCs via the PI3K/Akt/NF-κB signaling pathway. Calpain in PMCs might be a novel target for intervention in tuberculous pleural fibrosis. PMID:27261452

  14. Activation of calpain by renin-angiotensin system in pleural mesothelial cells mediates tuberculous pleural fibrosis.

    PubMed

    Yang, Jie; Xiang, Fei; Cai, Peng-Cheng; Lu, Yu-Zhi; Xu, Xiao-Xiao; Yu, Fan; Li, Feng-Zhi; Greer, Peter A; Shi, Huan-Zhong; Zhou, Qiong; Xin, Jian-Bao; Ye, Hong; Su, Yunchao; Ma, Wan-Li

    2016-07-01

    Pleural fibrosis is defined as an excessive deposition of extracellular matrix (ECM) components that results in destruction of the normal pleural tissue architecture. It can result from diverse inflammatory conditions, especially tuberculous pleurisy. Pleural mesothelial cells (PMCs) play a pivotal role in pleural fibrosis. Calpain is a family of calcium-dependent endopeptidases, which plays an important role in ECM remodeling. However, the role of calpain in pleural fibrosis remains unknown. In the present study, we found that tuberculous pleural effusion (TPE) induced calpain activation in PMCs and that inhibition of calpain prevented TPE-induced collagen-I synthesis and cell proliferation of PMCs. Moreover, our data revealed that the levels of angiotensin (ANG)-converting enzyme (ACE) were significantly higher in pleural fluid of patients with TPE than those with malignant pleural effusion, and ACE-ANG II in TPE resulted in activation of calpain and subsequent triggering of the phosphatidylinositol 3-kinase (PI3K)/Akt/NF-κB signaling pathway in PMCs. Finally, calpain activation in PMCs and collagen depositions were confirmed in pleural biopsy specimens from patients with tuberculous pleurisy. Together, these studies demonstrated that calpain is activated by renin-angiotensin system in pleural fibrosis and mediates TPE-induced collagen-I synthesis and proliferation of PMCs via the PI3K/Akt/NF-κB signaling pathway. Calpain in PMCs might be a novel target for intervention in tuberculous pleural fibrosis. PMID:27261452

  15. Serotype Distribution and Susceptibility of Streptococcus pneumoniae Isolates from Pleural Fluid in Spain from 1997 to 2008 ▿

    PubMed Central

    Fenoll, A.; Aguilar, L.; Vicioso, M. D.; Gimenez, M. J.; Robledo, O.; Granizo, J. J.; Mendez, C.

    2010-01-01

    Trends in serotype incidence and susceptibility (1997 to 2008) of Spanish Streptococcus pneumoniae pleural isolates (n = 831) were explored. Penicillin (oral) nonsusceptibility rates and the incidence of 7-valent pneumococcal conjugate vaccine (PCV-7) serotypes showed decreasing trends (R2 ≥ 0.600; P ≤ 0.002). The incidence of serotypes 1 and 19A showed increasing trends (R2 ≥ 0.759; P < 0.001), with no trends for serotype 3. Serotypes 19A, 1, and 3 represented 85% of pediatric isolates in 2008. In serotype 19A, the penicillin nonsusceptibility rate was 82.4% in 2008, associated with amoxicillin and cefotaxime nonsusceptibility in 21.4% of isolates. Inclusion of these serotypes in new vaccines offers the broadest coverage. PMID:20921314

  16. Advances in pleural disease management including updated procedural coding.

    PubMed

    Haas, Andrew R; Sterman, Daniel H

    2014-08-01

    Over 1.5 million pleural effusions occur in the United States every year as a consequence of a variety of inflammatory, infectious, and malignant conditions. Although rarely fatal in isolation, pleural effusions are often a marker of a serious underlying medical condition and contribute to significant patient morbidity, quality-of-life reduction, and mortality. Pleural effusion management centers on pleural fluid drainage to relieve symptoms and to investigate pleural fluid accumulation etiology. Many recent studies have demonstrated important advances in pleural disease management approaches for a variety of pleural fluid etiologies, including malignant pleural effusion, complicated parapneumonic effusion and empyema, and chest tube size. The last decade has seen greater implementation of real-time imaging assistance for pleural effusion management and increasing use of smaller bore percutaneous chest tubes. This article will briefly review recent pleural effusion management literature and update the latest changes in common procedural terminology billing codes as reflected in the changing landscape of imaging use and percutaneous approaches to pleural disease management.

  17. PLEURAL EFFECTS OF INDIUM PHOSPHIDE IN B6C3F1 MICE: NONFIBROUS PARTICULATE INDUCED PLEURAL FIBROSIS

    PubMed Central

    Kirby, Patrick J.; Shines, Cassandra J.; Taylor, Genie J.; Bousquet, Ronald W.; Price, Herman C.; Everitt, Jeffrey I.; Morgan, Daniel L.

    2010-01-01

    The mechanism(s) by which chronic inhalation of indium phosphide (InP) particles causes pleural fibrosis is not known. Few studies of InP pleural toxicity have been conducted because of the challenges in conducting particulate inhalation exposures, and because the pleural lesions developed slowly over the 2-year inhalation study. The authors investigated whether InP (1 mg/kg) administered by a single oropharyngeal aspiration would cause pleural fibrosis in male B6C3F1 mice. By 28 days after treatment, protein and lactate dehydrogenase (LDH) were significantly increased in bronchoalveolar lavage fluid (BALF), but were unchanged in pleural lavage fluid (PLF). A pronounced pleural effusion characterized by significant increases in cytokines and a 3.7-fold increase in cell number was detected 28 days after InP treatment. Aspiration of soluble InCl3 caused a similar delayed pleural effusion; however, other soluble metals, insoluble particles, and fibers did not. The effusion caused by InP was accompanied by areas of pleural thickening and inflammation at day 28, and by pleural fibrosis at day 98. Aspiration of InP produced pleural fibrosis that was histologically similar to lesions caused by chronic inhalation exposure, and in a shorter time period. This oropharyngeal aspiration model was used to provide an initial characterization of the progression of pleural lesions caused by InP. PMID:19995279

  18. Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion

    PubMed Central

    Verma, Akash; Phua, Chee Kiang; Sim, Wen Yuan; Algoso, Reyes Elmer; Tee, Kuan Sen; Lew, Sennen J. W.; Lim, Albert Y. H.; Goh, Soon Keng; Tai, Dessmon Y. H.; Kor, Ai Ching; Ho, Benjamin; Abisheganaden, John

    2016-01-01

    Abstract To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis. Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012. Univariate analyses showed lower pleural fluid LDH 667 (313–967) versus 971 (214–3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0.009, and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy 8 (89%) versus 26 (40%), P = 0.009 to correlate with survival of more than 1.7 year versus less than 1.7 year. In multivariate analysis, low pleural fluid LDH and female gender maintained significance. The pleural LDH level of ≤1500 and >1500 U/L discriminated significantly (P = 0.009) between survival. High pleural LDH (>1500 IU/L) predicts shorter survival (less than a year) in patients with adenocarcinoma lung presenting with MPE at the time of initial diagnosis. This marker may be clinically applied for selecting therapeutic modality directed at prevention of reaccumulation of MPE. Patients with low pleural LDH may be considered suitable for measures that provide more sustained effect on prevention of reaccumulation such as chemical pleurodesis or tunneled pleural catheter. PMID:27368006

  19. Fine-needle aspiration (FNA) and pleural fluid cytology diagnosis of benign metastasizing pleomorphic adenoma of the parotid gland in the lung: a case report and review of literature.

    PubMed

    Zhang, Yaxia; Gomez-Fernandez, Carmen R; Jorda, Merce; Ganjei-Azar, Parvin

    2009-11-01

    Lesions that contain abundant benign myoepithelial cells, including pleomorphic adenomas of salivary gland origin, may present a diagnostic challenge in fine-needle aspiration (FNA) specimens. Benign metastasizing pleomorphic adenoma is a rare neoplasm, in which the benign appearing pleomorphic adenoma, without any histological evidence of malignancy, metastasizes to distant sites including lung. In the absence of clinical history of a pre-existing myoepithelial neoplasm, the presence of myoepithelial cells in the lung or any other organs besides salivary glands may create diagnostic difficulty. Here we present the cytologic findings of such a metastatic tumor found in the lung FNA and pleural fluid specimens from a 64-year-old woman, with a history of local recurrent salivary gland pleomorphic adenomas, who presented with multiple bilateral pulmonary nodules and pleural effusion. The diagnosis of benign metastasizing pleomorphic adenoma was made based on clinical information and cytomorphology, and confirmed by immunocytochemistry.

  20. Memory-Like Antigen-Specific Human NK Cells from TB Pleural Fluids Produced IL-22 in Response to IL-15 or Mycobacterium tuberculosis Antigens

    PubMed Central

    Fu, Xiaoying; Yu, Sifei; Yang, Binyan; Lao, Suihua; Li, Baiqing; Wu, Changyou

    2016-01-01

    Our previous result indicated that memory-like human natural killer (NK) cells from TB pleural fluid cells (PFCs) produced large amounts of IFN-γ in response to Bacille Calmette Guerin (BCG). Furthermore, recent studies have shown that human lymphoid tissues harbored a unique NK cell subset that specialized in production of interleukin (IL)-22, a proinflammatory cytokine that mediates host defense against pathogens. Yet little information was available with regard to the properties of IL-22 production by memory-like human NK cells. In the present study, we found that cytokines IL-15 induced and IL-12 enhanced the levels of IL-22 by NK cells from TB PFCs. In addition, IL-22 but not IL-17 was produced by NK cells from PFCs in response to BCG and M.tb-related Ags. More importantly, the subset of specific IL-22-producing NK cells were distinct from IFN-γ-producing NK cells in PFCs. CD45RO+ or CD45RO- NK cells were sorted, co-cultured with autologous monocytes and stimulated with BCG for the production of IL-22. The result demonstrated that CD45RO+ but not CD45RO- NK cells produced significantly higher level of IL-22. Anti-IL-12Rβ1 mAbs (2B10) partially inhibit the expression of IL-22 by NK cells under the culture with BCG. Consistently, BCG specific IL-22-producing NK cells from PFCs expressed CD45ROhighNKG2Dhighgranzyme Bhigh. In conclusion, our data demonstrated that memory-like antigen-specific CD45RO+ NK cells might participate in the recall immune response for M. tb infection via producing IL-22, which display a critical role to fight against M. tb. PMID:27031950

  1. Mast cells mediate malignant pleural effusion formation

    PubMed Central

    Giannou, Anastasios D.; Marazioti, Antonia; Spella, Magda; Kanellakis, Nikolaos I.; Apostolopoulou, Hara; Psallidas, Ioannis; Prijovich, Zeljko M.; Vreka, Malamati; Zazara, Dimitra E.; Lilis, Ioannis; Papaleonidopoulos, Vassilios; Kairi, Chrysoula A.; Patmanidi, Alexandra L.; Giopanou, Ioanna; Spiropoulou, Nikolitsa; Harokopos, Vaggelis; Aidinis, Vassilis; Spyratos, Dionisios; Teliousi, Stamatia; Papadaki, Helen; Taraviras, Stavros; Snyder, Linda A.; Eickelberg, Oliver; Kardamakis, Dimitrios; Iwakura, Yoichiro; Feyerabend, Thorsten B.; Rodewald, Hans-Reimer; Kalomenidis, Ioannis; Blackwell, Timothy S.; Agalioti, Theodora; Stathopoulos, Georgios T.

    2015-01-01

    Mast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial. Here, we quantified MCs in human and murine malignant pleural effusions (MPEs) and evaluated the fate and function of these cells in MPE development. Evaluation of murine MPE-competent lung and colon adenocarcinomas revealed that these tumors actively attract and subsequently degranulate MCs in the pleural space by elaborating CCL2 and osteopontin. MCs were required for effusion development, as MPEs did not form in mice lacking MCs, and pleural infusion of MCs with MPE-incompetent cells promoted MPE formation. Once homed to the pleural space, MCs released tryptase AB1 and IL-1β, which in turn induced pleural vasculature leakiness and triggered NF-κB activation in pleural tumor cells, thereby fostering pleural fluid accumulation and tumor growth. Evaluation of human effusions revealed that MCs are elevated in MPEs compared with benign effusions. Moreover, MC abundance correlated with MPE formation in a human cancer cell–induced effusion model. Treatment of mice with the c-KIT inhibitor imatinib mesylate limited effusion precipitation by mouse and human adenocarcinoma cells. Together, the results of this study indicate that MCs are required for MPE formation and suggest that MC-dependent effusion formation is therapeutically addressable. PMID:25915587

  2. Pleural effusion as a result of chronic renal ischemia

    PubMed Central

    Akopov, Andrey; Semenov, Dmitry; Karev, Andrey; Filippov, Denis; Lukina, Olga

    2011-01-01

    We would like to present a case of patient with a transudative pleural effusion as a result of atherosclerotic occlusion of renal arteries. About 50 liters of fluid were drained from the right pleural cavity during 10 months period of observation. Successful revascularization of kidneys improved left ventricular function, stabilized hemodynamic of the pulmonary circulation and thus led to elimination of pleural effusion. PMID:22263089

  3. Pleural effusion as a result of chronic renal ischemia.

    PubMed

    Akopov, Andrey; Semenov, Dmitry; Karev, Andrey; Filippov, Denis; Lukina, Olga

    2011-09-01

    We would like to present a case of patient with a transudative pleural effusion as a result of atherosclerotic occlusion of renal arteries. About 50 liters of fluid were drained from the right pleural cavity during 10 months period of observation. Successful revascularization of kidneys improved left ventricular function, stabilized hemodynamic of the pulmonary circulation and thus led to elimination of pleural effusion. PMID:22263089

  4. Mycobacterium tuberculosis culture filtrate protein 10-specific effector/memory CD4⁺ and CD8⁺ T cells in tubercular pleural fluid, with biased usage of T cell receptor Vβ chains.

    PubMed

    Qiao, Dan; Li, Li; Guo, Jian; Lao, Suihua; Zhang, Xianlan; Zhang, Jianping; Wu, Changyou

    2011-08-01

    T cell-mediated immunity is critical for the control of Mycobacterium tuberculosis infection. Identifying the precise immune mechanisms that lead to control of initial M. tuberculosis infection and preventing reactivation of latent infection are crucial for combating tuberculosis. However, a detailed understanding of the role of T cells in the immune response to infection has been hindered. In addition, there are few flow cytometry studies characterizing the Vβ repertoires of T cell receptors (TCRs) at local sites of M. tuberculosis infection in adult tuberculosis. In this study, we used culture filtrate protein 10 (CFP-10) from M. tuberculosis to characterize T cells at local sites of infection. We simultaneously analyzed the correlation of the production of cytokines with TCR Vβ repertoires in CFP-10-specific CD4(+) and CD8(+) T cell subsets. For the first time, we demonstrate that CFP-10-specific CD4(+) or CD8(+) T cells from tubercular pleural fluid can produce high levels of gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) and upregulate the expression of CD107a/b on the cell surface. The CFP-10-specific cells were effector/memory cells with a CD45RO(+) CD62L(-) CCR7(-) CD27(-) expression profile. In addition, we found CFP-10-specific CD4(+) and CD8(+) T cells in tubercular pleural fluid, with biased usage of TCR Vβ9, Vβ12, or Vβ7.2. Our findings of CFP-10-specific CD4(+) and CD8(+) T cells in tubercular pleural fluid are critical for understanding the mechanisms of the local cellular immune response and developing more effective therapeutic interventions in cases of M. tuberculosis infection.

  5. CSF hydrothorax: An unusual cause of pleural effusion.

    PubMed

    Cato-Addison, William Bentil; Strachan, Roger

    2015-01-01

    A 20-year-old male with hydrocephalus managed with a ventriculoperitoneal shunt (VP) was diagnosed with a cerebrospinal fluid (CSF) pleural effusion. Imaging studies revealed an intrathoracic course of a disconnected VP shunt. Physicians should consider CSF effusion in their differential diagnosis in patients with a VP shunt and an unexplained pleural effusion.

  6. Effects of pneumothorax or pleural effusion on pulmonary function.

    PubMed Central

    Gilmartin, J J; Wright, A J; Gibson, G J

    1985-01-01

    The effects of pneumothorax or pleural effusion on respiratory function as measured by the commonly applied tests were investigated by studying 13 patients (six with pneumothorax, seven with effusion) with and, as far as possible, without air or fluid in the pleural cavity. Measurements included spirometric volumes, carbon monoxide transfer factor (TLCO), and KCO by the single breath method, maximum expiratory flow-volume curves, and subdivisions of lung volume estimated by both inert gas dilution and body plethysmography. In patients with pneumothorax "pleural volume" was estimated as the difference between lung volumes measured by dilution and thoracic gas volume measured by plethysmography. In patients with effusion the change in "pleural volume" was equated with the volume of fluid subsequently aspirated. "Total thoracic capacity" (TTC) was estimated by adding total lung capacity (TLC) measured by dilution and "pleural volume." Both effusion and pneumothorax produced a restrictive ventilatory defect with reductions of vital capacity, functional residual capacity, and TLC. In the patients with effusion TTC fell after aspiration, suggesting that the pleural fluid produced relative expansion of the chest wall as well as compression of the lung. In patients with pneumothorax, however, there was no difference in TTC with and without air in the pleural space. In the presence of pleural air or fluid there was a slight decrease in TLCO and increase in KCO, with a small but significant increase in the rate of lung emptying during forced expiration. PMID:3969656

  7. Disseminated plasma cell myeloma presenting as massive pleural effusion

    PubMed Central

    Babu, Kanahasubramanian Anand; Sundararajan, Lakshmikanthan; Prabu, Pandurangan; Parameswaran, Ashok

    2015-01-01

    Plasma cell myeloma (PCM) is a hematologic malignancy of plasma cell origin and usually associated with the presence of lytic bone lesions. Pleural effusions are rarely associated with PCM and most often signify a concurrent disease process. Malignant myelomatous pleural effusions are even more unusual and carry a poor prognosis. We report a unique case of unsuspected PCM with thoracic involvement in the form of massive left side pleural effusion. Pleural fluid cytology revealed numerous atypical plasma cells. Subsequently on further workup, urine Bence Jones protein was positive. Bone marrow aspiration and biopsy and computed tomography of the chest and abdomen revealed features consistent with multiple myeloma. PMID:26664659

  8. Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

    PubMed Central

    Lee, Myung-Ki; Kim, Woo-Jae; Kim, Ho-Sang; Kim, Jeong-Ho; Kim, Yun-Suk

    2016-01-01

    Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion. PMID:27799999

  9. IL-5 in post-traumatic eosinophilic pleural effusion.

    PubMed Central

    Schandené, L; Namias, B; Crusiaux, A; Lybin, M; Devos, R; Velu, T; Capel, P; Bellens, R; Goldman, M

    1993-01-01

    Thoracic trauma or pneumothorax can result in pleural fluid eosinophilia. In this study we investigated the role of the eosinophilopoietic cytokine IL-5 in three cases of post-traumatic eosinophilic pleural effusions (EPE). Using a specific immunoenzymatic assay, significant levels of IL-5 were found in EPE (range 100-3000 pg/ml), while IL-5 was undetectable (< 25 pg/ml) in corresponding serum samples and in non-eosinophilic pleural fluids. IL-5 present in pleural fluids was found bioactive in a proliferative assay using a mouse CTLL-2 cell line transfected with the cDNA corresponding to the alpha chain of the human IL-5 receptor. Using a reverse polymerase chain reaction (PCR) method, we found IL-5 mRNA expression within pleural mononuclear cells from patients with EPE, but not in corresponding peripheral blood mononuclear cells (PBMC), confirming that IL-5 is synthesized locally in the pleural cavity. In the two cases in which pleural CD4+ cells were purified, these cells were identified as the major source of IL-5. Taken together, these data indicate that the development of post-traumatic EPE is related to a local secretion of IL-5 by CD4+ cells present in the pleural cavity. Images Fig. 1 PMID:8100745

  10. Metastatic pleural tumor

    MedlinePlus

    ... persons. Alternative Names Tumor - metastatic pleural Images Pleural space References Arenberg D, Pickens A. Metastatic malignant tumors. In: Mason RJ, Murray JF, Broaddus VC, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine . 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap ...

  11. Peritoneal Fluid Analysis

    MedlinePlus

    ... limited. Home Visit Global Sites Search Help? Peritoneal Fluid Analysis Share this page: Was this page helpful? Formal name: Peritoneal Fluid Analysis Related tests: Pleural Fluid Analysis , Pericardial Fluid ...

  12. Pleural ultrasonography. Pictorial essay.

    PubMed

    Chira, Romeo; Chira, Alexandra; Mânzat Săplăcan, Roberta; Nagy, Georgiana; Binţinţan, Adriana; Mircea, Petru Adrian

    2014-12-01

    Pleural ultrasonography (US) represents nowadays a useful diagnostic tool in the management of pleural diseases. Detection and evaluation of pleural effusions, pneumothorax and pleural-based lesions can be performed with US, which has the advantages of wide availability, low cost, absence of radiation exposure, and portability. It is the best method for guiding interventional procedures in the pleural space. It has also limitations, due to the interposition of bony parts of the thorax, subcutaneous emphysema and inability to visualize the mediastinal pleura. US of the thorax is an operator dependent technique demanding an experienced operator in order to obtain reliable results. This pictorial essay presents various ultrasound findings of the diseases which concern the pleura.

  13. Spatial context learning approach to automatic segmentation of pleural effusion in chest computed tomography images

    NASA Astrophysics Data System (ADS)

    Mansoor, Awais; Casas, Rafael; Linguraru, Marius G.

    2016-03-01

    Pleural effusion is an abnormal collection of fluid within the pleural cavity. Excessive accumulation of pleural fluid is an important bio-marker for various illnesses, including congestive heart failure, pneumonia, metastatic cancer, and pulmonary embolism. Quantification of pleural effusion can be indicative of the progression of disease as well as the effectiveness of any treatment being administered. Quantification, however, is challenging due to unpredictable amounts and density of fluid, complex topology of the pleural cavity, and the similarity in texture and intensity of pleural fluid to the surrounding tissues in computed tomography (CT) scans. Herein, we present an automated method for the segmentation of pleural effusion in CT scans based on spatial context information. The method consists of two stages: first, a probabilistic pleural effusion map is created using multi-atlas segmentation. The probabilistic map assigns a priori probabilities to the presence of pleural uid at every location in the CT scan. Second, a statistical pattern classification approach is designed to annotate pleural regions using local descriptors based on a priori probabilities, geometrical, and spatial features. Thirty seven CT scans from a diverse patient population containing confirmed cases of minimal to severe amounts of pleural effusion were used to validate the proposed segmentation method. An average Dice coefficient of 0.82685 and Hausdorff distance of 16.2155 mm was obtained.

  14. Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection.

    PubMed

    Piccolo, Francesco; Popowicz, Natalia; Wong, Donny; Lee, Yun Chor Gary

    2015-06-01

    Pleural infection remains a global health burden associated with significant morbidity. Drainage of the infected pleural fluid is important but can often be hindered by septations and loculations. Intrapleural fibrinolytic therapy alone, to break pleural adhesions, has shown no convincing advantages over placebo in improving clinical outcome. Deoxyribonucleoprotein from degradation of leukocytes contributes significantly to high viscosity of infected pleural fluid. Recombinant deoxyribonuclease (DNase) is effective in reducing pleural fluid viscosity in pre-clinical studies. The combination of tissue plasminogen activator (tPA) and DNase was effective in animal model experiments of empyema. The benefits were established in a randomized clinical trial: those (n=48) treated with tPA/DNase had significantly improved radiological outcomes and reduced need of surgery and duration of hospital stay. A longitudinal observational series of 107 patients further confirmed the effectiveness and safety of tPA/DNase therapy, including its use as 'rescue therapy' when patients failed to respond to antibiotics and chest tube drainage. Overall, a short course of intrapleural tPA (10 mg) and DNase (5 mg) therapy provides a cure in over 90% of patients without requiring surgery. The treatment stimulates pleural fluid formation, enhances radiographic clearance and resolution of systemic inflammation. Serious complications are uncommon; pleural bleeding requiring transfusion occurred in ~2% of cases. Pain can occur, especially with the first dose. Treatment is contraindicated in those with significant bleeding diathesis or a bronchopleural fistula. Future research is required to optimize dosing regimens and in refining patient selection. PMID:26150913

  15. Pleural malignancies including mesothelioma.

    PubMed

    Hillerdal, G

    1995-07-01

    Malignant mesothelioma is caused almost exclusively by occupational exposure to asbestos. During the past few years, however, increasing evidence has mounted that background exposure to asbestos could be sufficient to cause mesothelioma. Treatment of malignant mesothelioma remains a big problem. Some new approaches are on their way, and the most exciting ones are local immunotherapy in very early cases. Some success has been reported with local interferon treatment. As for treatment of metastatic pleural disease, the main purpose is symptomatic relief of dyspnea caused by fluid accumulation. The best way to achieve a lasting palliation is pleurodesis, and the most common way to do this, is by chemical means. The drug of choice in the United States has for many years been tetracycline, but since injectable tetracycline is no longer available, some substitute must be found. The substance that will "win" is not yet clear, but the two leading contestants are talc and doxycycline. Bleomycin also has its supporters, and a dark horse is quinacrine, which although not easily available in the United States, has been used in many European centers for decades. PMID:9363074

  16. [Sonography in pleural effusion of horses].

    PubMed

    Stadtbäumer, G

    1989-01-01

    Pleural effusion in the horse can be caused by diseases such as pneumonia, trauma, pulmonary abscesses and thoracic neoplasms. Besides clinical (auscultation, percussion) and radiographic diagnostic procedures, the ultrasonic examination represents a method that supplies detailed information on quantity and location of fluid in the pleural space. By means of ultrasonic examination the most favourable position for a thoracentesis can be determined. Control of thoracentesis' efficiency as well as exact supervision of the disease's course are made feasible by repeated sonographic examinations. PMID:2694447

  17. Cocaine Induced Pleural and Pericardial Effusion Syndrome

    PubMed Central

    Alqalyoobi, Shehabaldin; Vaidya, Omkar; Abu Ghanimah, Al-Ma'Mon; Elkhanany, Ahmed; Gohar, Ashraf

    2015-01-01

    A 42-year-old African American female with chronic cocaine use for 20 years, presented with two-day history of exertional shortness of breath and pleuritic chest pain. She was admitted three years back with acute kidney injury and skin rashes. At that time, skin biopsy was consistent with leukocytoclastic vasculitis and renal biopsy revealed proliferative glomerulonephritis. She responded to oral prednisone and mycophenolate with complete recovery of her kidney functions. Skin rash was waxing and waning over the last two years. On the second admission, patient was found to have large pleural effusion on computerized tomography scan and pericardial effusion on echocardiogram as shown in the figures. Pleural fluid analysis was exudative. Her serology was negative for ANA (antineutrophilic antibody) and anti-dsDNA (double stranded DNA). Complements levels were normal. She had positive low titers of ANCA levels. The patient was started on a course of prednisone for 6 months. Her pleural and pericardial effusion resolved completely on follow-up imaging with computerized tomography scan and echocardiogram. This case is unique since the pericardial and pleural effusions developed without any other etiology in the setting of cocaine; hence, we describe this clinical syndrome as cocaine induced pleural and pericardial effusions syndrome (CIPP). PMID:25918664

  18. Cocaine induced pleural and pericardial effusion syndrome.

    PubMed

    Alqalyoobi, Shehabaldin; Vaidya, Omkar; Abu Ghanimah, Al-Ma'Mon; Elkhanany, Ahmed; Gohar, Ashraf

    2015-01-01

    A 42-year-old African American female with chronic cocaine use for 20 years, presented with two-day history of exertional shortness of breath and pleuritic chest pain. She was admitted three years back with acute kidney injury and skin rashes. At that time, skin biopsy was consistent with leukocytoclastic vasculitis and renal biopsy revealed proliferative glomerulonephritis. She responded to oral prednisone and mycophenolate with complete recovery of her kidney functions. Skin rash was waxing and waning over the last two years. On the second admission, patient was found to have large pleural effusion on computerized tomography scan and pericardial effusion on echocardiogram as shown in the figures. Pleural fluid analysis was exudative. Her serology was negative for ANA (antineutrophilic antibody) and anti-dsDNA (double stranded DNA). Complements levels were normal. She had positive low titers of ANCA levels. The patient was started on a course of prednisone for 6 months. Her pleural and pericardial effusion resolved completely on follow-up imaging with computerized tomography scan and echocardiogram. This case is unique since the pericardial and pleural effusions developed without any other etiology in the setting of cocaine; hence, we describe this clinical syndrome as cocaine induced pleural and pericardial effusions syndrome (CIPP).

  19. Pleural needle biopsy

    MedlinePlus

    ... lungs and chest wall (pleural membrane). A larger, hollow needle is then placed gently through the skin ... the needle. A smaller cutting needle inside the hollow one is used to collect tissue samples. During ...

  20. Concurrent pericardial and pleural effusions: a double jeopardy.

    PubMed

    Furst, Branko; Liu, Chyong-Jy J; Hansen, Philip; Musuku, Sridhar R

    2016-09-01

    A 19-year-old man with large malignant pleural and pericardial effusions with tamponade physiology and signs of congestive heart failure presented for emergent subxiphoid pericardial window. Surgical drainage of the pericardium was complicated by a paradoxical cardiovascular collapse that failed to respond to pressors and intravenous fluids. Suspecting a pericardial perforation, a median sternotomy was performed and revealed an intact heart. The arterial pressure was promptly restored after drainage of the pleural effusion. It is proposed that, in patients presenting with tamponading pericardial and pleural effusions, drainage of the pleural effusion be given priority. The pathophysiology of low cardiac output states resulting from pericardial and large pleural effusion is discussed and the literature reviewed. PMID:27555190

  1. Modified TB rapid test by proteinase K for rapid diagnosis of pleural tuberculosis.

    PubMed

    Yari, Shamsi; Hadizadeh Tasbiti, Alireza; Ghanei, Mostafa; Shokrgozar, Mohammad Ali; Fateh, Abolfazl; Yari, Fatemeh; Bahrmand, Ahmadreza

    2016-03-01

    The diagnosis of pleural tuberculosis continues to be a challenge due to the low sensitivity of traditional diagnostic methods. Better and more rapid tests are needed for diagnosis of pleural TB. In this study, pleural fluids were tested with rapid test to determine Mycobacterium tuberculosis (MTB antigen). Affinity chromatography was used to purify specific polyclonal antibodies against MTB antigen. Pleural samples after decontamination were treated with proteinase K. Rapid test for pleural fluids was prepared by specific antibody. Rapid test was performed on 85 pleural fluid patients. The patients had a mean age of 46.55 ± 15.96 years and 38 were men. The performance of rapid test, using proteinase K, was found to be the most impressive: sensitivity 93%, specificity 94%, PPV 90%, and NPV 96% compared with adenosine deaminase test (ADA), PCR, smear, and culture. The present study did demonstrate that modified TB rapid test can substantially improve the diagnosis of extrapulmonary TB.

  2. Usefulness of pleural effusion antinuclear antibodies in the diagnosis of lupus pleuritis.

    PubMed

    Toworakul, C; Kasitanon, N; Sukitawut, W; Wichinun, R; Louthrenoo, W

    2011-10-01

    We performed this study to determine sensitivity and specificity of pleural effusion antinuclear antibodies (ANA) at a titer of ≥1 : 160, and the ratio of pleural effusion to serum ANA of ≥1, to distinguish between pleural fluid from lupus pleuritis and other causes. A prospective study of 54 patients with pleural effusion (12 lupus pleuritis, seven parapneumonic effusion, 26 malignancy-associated pleural effusions, nine transudative effusions) was performed. ANA at a titer of ≥1 : 160 were found in 11 of 12 lupus pleuritis samples, and in four of 42 pleural effusions from non-systemic lupus erythematosus (SLE) patients. The pleural effusion ANA at a titer of ≥1 : 160 gave a sensitivity of 91.67% for lupus pleuritis, with a specificity of 83.33% when compared with all other pleural effusions, 90.91% when compared with exudative effusion (parapneumonic effusion and malignancy-associated effusion) and 55.56% when compared with the transudative pleural effusion group. Using the ratio of pleural effusion to serum ANA of ≥1, the sensitivity and the specificity decreased to 75.00% and 78.57%, respectively. This study provides further evidence that the pleural effusion ANA at a titer of ≥1 : 160 is a sensitive and specific diagnostic biomarker for lupus pleuritis in patients with lupus. However, pleural effusion ANA can occasionally be found in other conditions.

  3. [Parapneumonic pleural effusions and empyema in adults:current practice].

    PubMed

    Porcel, J M; Light, R W

    2009-11-01

    About 20% of hospitalized patients with bacterial pneumonia have an accompanying pleural effusion. Parapneumonic effusions (PPE) are associated with a considerable morbidity and mortality. The main decision in managing a patient with a PPE is whether to insert a chest tube (complicated PPE). Imaging (i.e., chest radiograph, ultrasound and computed tomography) and pleural fluid analysis (i.e., pH, glucose, lactate dehydrogenase, bacterial cults) provide essential information for patient management. Therefore, all PPEs should be aspirated for diagnostic purposes. This may require image-guidance if the effusion is small or heavily loculated. According to the current guidelines, any PPE that fulfills at least one of the following criteria should be drained: size > or = 1/2 of the hemithorax, loculations, pleural fluid pH < 7.20 (or alternatively pleural fluid glucose < 60 mg/dl), positive pleural fluid Gram stain or culture, or purulent appearance. The key components of the treatment of complicated PPE and empyema are the use of appropriate antibiotics, provision of nutritional support, and drainage of the pleural space by one of the following methods: therapeutic thoracentesis, tube thoracostomy, intrapleural fibrinolytics, thoracoscopy with breakdown of adhesions or thoracotomy with decortication. The routine use of intrapleural fibrinolytic therapy remains controversial. (c) 2009 Elsevier España, S.L. All rights reserved. PMID:19889319

  4. Characterisation of pleural inflammation occurring after primary spontaneous pneumothorax.

    PubMed

    De Smedt, A; Vanderlinden, E; Demanet, C; De Waele, M; Goossens, A; Noppen, M

    2004-06-01

    The aim of this study was to examine the inflammatory reaction occurring in the pleural space of patients suffering from primary spontaneous pneumothorax (PSP) using pleural lavage, which was performed in patients with PSP and in healthy control subjects (essential hyperhidrosis patients undergoing thoracoscopy for sympathicolysis treatment). Cellular and solute composition of lavage fluid, peripheral blood and parietal pleural biopsies were analysed. PSP lavage fluid showed an increase in all differentiated leucocytes, but most strikingly eosinophils and neutrophils. In the blood of patients with PSP, the total number of leucocytes and the absolute number of eosinophils, neutrophils and monocytes were also significantly increased. The time in which air was present in the pleural space was positively correlated with the increase of eosinophils in lavage fluid, parietal pleura and blood. Eosinophilic cationic protein was elevated after PSP and strongly correlated with the absolute number of lavage eosinophils. Chemo and cytokine analysis in lavage fluid showed differences in concentrations of interleukin (IL)-5, IL-6, IL-8, IL-12p40, tumour necrosis factor-alpha and RANTES, but not of eotaxin. Surprisingly, high levels of lipopolysaccharide binding protein were also measured. Primary spontaneous pnumothorax is associated with a substantial pleural inflammatory reaction. The authors hypothesise that mechanical stretch factors, lipopolysaccharide binding protein/lipopolysaccharide complexes or other environmental components trigger pleural inflammation after primary spontaneous pnumothorax. PMID:15219004

  5. Analysis of Lymphocyte Immunological Reactivity in Patients with Pleural Effusions of Different Aetiology

    PubMed Central

    Goseva, Zlatica; Kaeva, Biserka Jovkovska; Gjorcev, Angelko; Janeva, Elena Jovanovska; Arsovski, Zoran; Pejkovska, Sava; Tatabitovska, Aleksandra

    2016-01-01

    BACKGROUND: The proportion of T and B lymphocytes in pleural fluids and blood may point to the presence of local immunological phenomena in pleural disorders. AIM: Aim of study was to evaluate the lymphocyte phenotype and the ratio between helper (CD4+) and cytotoxic/suppressor (CD8+) lymphocytes in malignant and non-malignant effusions. MATERIAL AND METHODS: We studied 48 patients with pleural effusions. First group had 18 patients with tuberculosis pleural effusions; second group had 20 patients with malignant pleural fluids, third group had 10 patients with transudates and 30 healthy controls. We investigated the distribution of T and B lymphocytes, T cells with helper/inducer CD4 or suppresser/cytotoxic CD8 phenotypes and the CD16 subset. RESULTS: Results showed decreases levels of CD3, CD4, and CD16 T cells in blood of patients versus healthy controls. There were increases in the percentage of the CD3 and CD4 T cells in the pleural fluid compared with values in the blood with statistical significance in tuberculous pleurisy. The values of CD8 were similar in the pleural fluid and in blood. Levels of CD16 were non-significantly higher in pleural fluid in all groups. CONCLUSION: This study confirms the hypothesis that pleural cavity is compartment with immunological reactivity and results could be used in differential diagnosis together with other examinations. PMID:27275329

  6. Pleurodesis with doxycycline or Corynebacterium parvum in malignant pleural effusion.

    PubMed

    Salomaa, E R; Pulkki, K; Helenius, H

    1995-01-01

    Pleurodesis with doxycycline (100 mg and 600 mg) and Corynebacterium parvum (1 mg and 7 mg) were compared in 41 patients with malignant effusion. To evaluate the mechanisms, pleural fluid pH, leukocytes, granulocytes, interleukin-6 (IL-6) and serum IL-6, as well as C-reactive protein (CRP) were measured before and on 2 consecutive days after treatment. Corynebacterium parvum produced a greater acute-phase response measured with fever, serum CRP and IL-6 than doxycycline. However, no change in pleural fluid IL-6 was demonstrated. Among the 35 assessed patients, 26 had objective response, similar in all four treatment groups. Side-effects were more common with Corynebacterium parvum. Based on this preliminary study we conclude that doxycycline, even in low doses, is a highly effective and well tolerated agent for palliative treatment of malignant pleural effusion. As the responses were similar despite different inflammatory reactions, the two agents probably induce pleural obliteration through different mechanisms. PMID:7865226

  7. Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

    PubMed Central

    Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Kim, Jung Soo; Park, Hye Yun

    2016-01-01

    Objective To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. Materials and Methods We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. Results The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410–100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. Conclusion In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion. PMID:26957917

  8. Pleural haemangioma: A rare cause of recurrent pleural effusion.

    PubMed

    Sindhwani, G; Khanduri, R; Nadia, S; Jethani, V

    2016-01-01

    A middle aged female presented with recurrent unilateral pleural effusion. Thoracoscopy revealed a vascular tumor in the apical region of pleural cavity arising from the chest wall. Biopsy from the tumor showed features of pleural hemangioma. She was successfully managed by surgical excision of the tumor. The case is being presented because of its rarity.

  9. Primary extraskeletal pleural osteosarcoma: a rare pleural identity

    PubMed Central

    Copeland, Hannah; Makdisi, Peter B.; Duncan, Michael; Wozniak, Thomas C.

    2016-01-01

    A 69-year-old female with a history of a heart transplant 16 years prior, presented with a large left chest mass identified on fluoroscopy in the cardiac catheterization lab. The patient noted a 40 pound weight loss in one year. A chest X-ray (CXR) and chest computed tomography (CT) demonstrated a large complex cystic mass in the left chest. A CT guided aspiration was performed, and the cytology for the cyst fluid was negative for malignancy. The patient continued to have worsening shortness of breath, a repeat chest CT scan and magnetic resonance imaging (MRI) three months later, demonstrated a recurrence of the left pleural mass. Further, work-up was negative for tumor. A left video assisted thoracotomy exploration was performed and left thoracotomy was needed for the mass resection. The final pathology demonstrated a high grade osteosarcoma. The post-operative course was unremarkable. PMID:27386494

  10. Aetiology of pleural plaques

    PubMed Central

    Rous, V.; Studeny, J.

    1970-01-01

    Pleural plaques were found in 644 (6·6%) of 9,760 photofluorograms taken in 1965 in a region of Pelhřimov district; the incidence was highest in the age group 66-70 years. The advanced age of those affected may be explained by the greater frequency of the causative agent in the past. The disorder was known in Pelhřimov district as early as 1930; it was then thought to be posttuberculous. The past history of the cases was uninformative; as a rule, the only common previous disease was pleurisy with effusion, occurring in 9·7%. The general condition of those affected was excellent; only 8% were aware of the fact that pleural lesions were present. The disorder was found mainly in farmers, familial incidence was common, and if two generations of one family suffered from the condition, the older generation was affected in 100%. Pleural plaques consist morphologically of limited areas of hyalinized collagenous connective tissue with calcium salt deposits. Tubercle bacilli could not be cultivated from the lesions. Mineralological analysis showed no evidence of silicates in the pleural plaques and a normal content in the lungs. The aetiological factor responsible for the development of pleural plaques in Pelhřimov district is not known, but asbestos cannot be implicated. The unknown noxious agent is carried to the pleura by the lymph and blood stream. Pleural plaques are an endemic disorder. The traditional view that lesions are post-tuberculous appears, in the region submitted to this study, to be a possible explanation. Images PMID:5465601

  11. The management of benign non-infective pleural effusions.

    PubMed

    Bintcliffe, Oliver J; Lee, Gary Y C; Rahman, Najib M; Maskell, Nick A

    2016-09-01

    The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting. PMID:27581830

  12. Switching off malignant pleural effusion formation—fantasy or future?

    PubMed Central

    Giannou, Anastasios D.; Stathopoulos, Georgios T.

    2015-01-01

    Malignant pleural effusion (MPE) is common and difficult to treat. In the vast majority of patients the presence of MPE heralds incurable disease, associated with poor quality of life, morbidity and mortality. Current therapeutic approaches are inefficient and merely offer palliation of associated symptoms. Recent scientific progress has shed light in the biologic processes governing the mechanisms behind the pathobiology of MPE. Pleural based tumors interfere with pleural fluid drainage, as well as the host vasculature and immune system, resulting in decreased fluid absorption and increased pleural fluid production via enhanced plasma extravasation into the pleural space. In order to achieve this feat, pleural based tumors must elicit critical vasoactive events in the pleura, thus forming a favorable microenvironment for tumor dissemination and MPE development. Such properties involve specific transcriptional signaling cascades in addition to secretion of important mediators which attract and activate host cell populations which, in turn, impact tumor cell functions. The dissection of the biologic steps leading to MPE formation provides novel therapeutic targets and recent research findings provide encouraging results towards future therapeutic innovations in MPE management. PMID:26150914

  13. A potential role for VEGF in the diagnostic approach of pleural effusions

    PubMed Central

    Psatha, Aggeliki; Makris, Demosthenes; Daniil, Zoe; Kiropoulos, Theodoros; Gourgoulianis, Konstantinos

    2016-01-01

    Background Vascular endothelial growth factor (VEGF) may play a role in pleural fluid formation, as it represents a potent inducer of capillary permeability. We aimed to investigate the diagnostic utility of VEGF levels in pleural fluid and serum in patients with pleural effusions with initially negative diagnostic work up. Methods Seventy-one patients with exudative lymphocytic pleural effusions undiagnosed after initial diagnostic work up were enrolled in this prospective study and their clinical course was followed up to 24 months. VEGF levels were measured in serum and pleural fluid by using immunoenzymometric assay. Results During the follow up period, in 43 patients the pleural effusion was eventually attributed to malignancy while in the rest 28 patients it was due to non-malignant causes (benign and unknown origin). Patients with malignancy had significantly higher VEGF levels in pleural fluid compared to patients with non-malignant effusions (1,506 vs. 588 pg/dL, P=0.0001), while no statistically significant difference was found in the VEGF serum levels between the two groups. Conclusions Pleural VEGF levels may be helpful in identifying malignant pleural effusion (MPE) in patients with negative diagnostic work up at the initial assessment and help in selecting patients for more invasive procedures. PMID:27499957

  14. Procalcitonin levels in salmonella infection

    PubMed Central

    Mishra, Vikas; Sorabjee, Jehangir

    2015-01-01

    Aim: Procalcitonin (PCT) as a diagnostic marker for bacteremia and sepsis has been extensively studied. We aimed to study PCT levels in Salmonella infections whether they would serve as marker for early diagnosis in endemic areas to start empiric treatment while awaiting blood culture report. Materials and Methods: BACTEC blood culture was used to isolate Salmonella in suspected enteric fever patients. Serum PCT levels were estimated before starting treatment. Results: In 60 proven enteric fever patients, median value of serum PCT levels was 0.22 ng/ml, values ranging between 0.05 and 4 ng/ml. 95% of patients had near normal or mild increase (<0.5 ng/ml), only 5% of patients showed elevated levels. Notably, high PCT levels were found only in severe sepsis. Conclusion: PCT levels in Salmonella infections are near normal or minimally increased which differentiates it from other systemic Gram-negative infections. PCT cannot be used as a specific diagnostic marker of typhoid. PMID:26321807

  15. Clinical and Laboratory Differences between Lymphocyte- and Neutrophil-Predominant Pleural Tuberculosis

    PubMed Central

    Kim, Kang; Kim, Sukyeon; Oh, Ki-Jong; Jeong, Suk Hyeon; Jung, Woo Jin; Shin, Beomsu; Jhun, Byung Woo; Lee, Hyun; Park, Hye Yun; Koh, Won-Jung

    2016-01-01

    Pleural tuberculosis (TB), a form of extrapulmonary TB, can be difficult to diagnose. High numbers of lymphocytes in pleural fluid have been considered part of the diagnostic criteria for pleural TB; however, in many cases, neutrophils rather than lymphocytes are the predominant cell type in pleural effusions, making diagnosis more complicated. Additionally, there is limited information on the clinical and laboratory characteristics of neutrophil-predominant pleural effusions caused by Mycobacterium tuberculosis (MTB). To investigate clinical and laboratory differences between lymphocyte- and neutrophil-predominant pleural TB, we retrospectively analyzed 200 patients with the two types of pleural TB. Of these patients, 9.5% had neutrophil-predominant pleural TB. Patients with lymphocyte-predominant and neutrophil-predominant pleural TB showed similar clinical signs and symptoms. However, neutrophil-predominant pleural TB was associated with significantly higher inflammatory serum markers, such as white blood cell count (P = 0.001) and C-reactive protein (P = 0.001). Moreover, MTB was more frequently detected in the pleural fluid from patients in the neutrophil-predominant group than the lymphocyte-predominant group, with the former group exhibiting significantly higher rates of positive results for acid-fast bacilli in sputum (36.8 versus 9.4%, P = 0.003), diagnostic yield of MTB culture (78.9% versus 22.7%, P < 0.001) and MTB detected by polymerase chain reaction (31.6% versus 5.0%, P = 0.001). Four of seven patients with repeated pleural fluid analyses revealed persistent neutrophil-predominant features, which does not support the traditional viewpoint that neutrophil-predominant pleural TB is a temporary form that rapidly develops into lymphocyte-predominant pleural TB. In conclusion, neutrophil-predominant pleural TB showed a more intense inflammatory response and a higher positive rate in microbiological testing compared to lymphocyte-predominant pleural TB

  16. Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

    PubMed Central

    Mortazavi-Moghaddam, Sayyed Gholam Reza; Sharifzadeh, Gholam Reza; Rezvani, Mohammad Reza

    2016-01-01

    The causes and situation of exudative pleural effusion vary from one area to another. A cross-sectional study was conducted on 327 patients with exudative pleural effusion in South Khorasan province (Iran). The patients were older than 12 years and comprised 172 (52.6%) males and 155 (47.4%) females. The study commenced in 2007 with seven years duration. The Light’s criteria were used to define exudative effusion. Procedures including pleural fluid analysis, microbiological study, pleural biopsy, and systemic investigations were conducted to determine the special cause of pleural effusion. The mean age of the patients was 63.4±18.4 years. Malignancies, tuberculosis, and parapneumonia pleural exudation were diagnosed in 125 (38.2%), 48 (14.7%), and 45 (13.8%) cases, respectively. Among malignant effusions, metastasis from lung cancer made 48 (38.4%) of the cases. The origin of metastasis was not determined in 44 (35.2%) patients. The mean age of patients was not significantly different between malignant (66.9±14.3 years) and tuberculosis (63.9±19.7 years) cases (P=0.16). The older age of tuberculosis patients could be a new discussion point on the overall impression created on the subject of tuberculosis pleural exudation (TB-PLE) occurring in young people. PMID:27365554

  17. Host response biomarkers in sepsis: the role of procalcitonin.

    PubMed

    Vincent, Jean-Louis; Van Nuffelen, Marc; Lelubre, Christophe

    2015-01-01

    Procalcitonin is the prohormone of calcitonin and present in minute quantities in health. However, during infection, its levels rise considerably and are correlated with the severity of the infection. Several assays have been developed for measurement of procalcitonin levels; in this article, we will briefly present the PCT-sensitive Kryptor(®) test (Brahms, Hennigsdorf, Germany), one of the most widely used assays for procalcitonin in recent studies. Many studies have demonstrated the value of procalcitonin levels for diagnosing sepsis and assessing disease severity. Procalcitonin levels have also been successfully used to guide antibiotic administration. However, procalcitonin is not specific for sepsis, and values need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis.

  18. Intra-Pleural Colistin Methanesulfonate Therapy for Pleural Infection caused by Carbapenem-Resistant Acinetobacter Baumannii: A Successful Case Report.

    PubMed

    Rana, Muhammad Asim; Rahman, Basheer Abd El; Mady, Ahmed Fouad; Odat, Mohammed Al; AlHarthy, Abdurehman; Ramadan, Omar El Sayed; Mumtaz, Shahzad Ahmed; Omrani, Ali S

    2014-08-13

    Infections caused by carbapenem-resistant, Gram-negative bacteria are an increasing clinical challenge, since the antimicrobial treatment options are often limited to colistin methanesulfonate. No data are available regarding the pharmacokinetics of colistin in pleural fluid. We report the case of a 92-year old man with ventilator-associated pneumonia and pleurisy caused by Acinetobacter baumannii and Escherichia coli, which were both multidrug-resistant. After an unsuccessful treatment with intravenous colistin methanesulfonate and imipen-em-cilastatin, the addition of intra-pleural colistin methanesulfonate to the intravenous treatment led to a prompt clinical, radiological and microbiological resolution. This is the first report of a successful use of intra-pleural colistin in the literature. The intra-pleural colistin therapy should be considered in selected cases of pleurisy caused by multi-resistant Gram-negative bacteria.

  19. Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion

    PubMed Central

    Akturk, Ulku Aka; Ernam, Dilek; Akbay, Makbule Ozlem; Koçak, Nagihan Durmus; Ogur, Erhan; Irmak, Ilim

    2016-01-01

    OBJECTIVES: Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion. METHODS: Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter. RESULTS: A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition. CONCLUSION: The pleural fluid neutrophil-lymphocyte ratio, which is an

  20. Management of Parapneumonic Pleural Effusion in Adults.

    PubMed

    Ferreiro, Lucía; San José, María Esther; Valdés, Luis

    2015-12-01

    Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results. The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed. Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease. PMID:25820035

  1. Management of Parapneumonic Pleural Effusion in Adults.

    PubMed

    Ferreiro, Lucía; San José, María Esther; Valdés, Luis

    2015-12-01

    Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results. The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed. Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease.

  2. Vandetanib and indwelling pleural catheter for non-small cell lung cancer with recurrent malignant pleural effusion

    PubMed Central

    Massarelli, Erminia; Onn, Amir; Marom, Edith M.; Alden, Christine M.; Liu, Diane D.; Tran, Hai T.; Mino, Barbara; Wistuba, Ignacio I.; Faiz, Saadia A.; Bashoura, Lara; Eapen, George A.; Morice, Rodolfo C.; Jack Lee, J.; Hong, Waun K.; Herbst, Roy S.; Jimenez, Carlos A.

    2014-01-01

    Background Non-small-cell lung cancer patients with malignant pleural effusion have a poor overall median survival (4.3 months). Vascular endothelial growth factor (VEGF) is a key regulator of pleural effusion production. It is unknown if pharmacological inhibition of VEGF signaling modifies the disease course of non-small-cell lung cancer patients with recurrent malignant pleural effusion. We report the final results of a single-arm phase II clinical trial of the VEGF receptor inhibitor vandetanib combined with intrapleural catheter placement in patients with non-small-cell lung cancer and recurrent malignant pleural effusion, to determine whether vandetanib reduces time to pleurodesis. Material and Methods Non-small-cell lung cancer patients with proven metastatic disease to the pleural space by pleural fluid cytology or pleural biopsy who required intrapleural catheter placement were eligible for enrollment. On the same day of the intrapleural catheter insertion, the patients were started on a daily oral dose of 300 mg vandetanib, for a maximum of 10 weeks. The primary endpoint was time to pleurodesis, with response rate as the secondary endpoint. Exploratory analyses included measurement of pleural fluid cytokines and angiogenic factors before and during therapy. Results Twenty eligible patients were included in the trial. Eleven patients completed 10 weeks of treatment. Median time to pleurodesis was 35 days (95% confidence interval 15, NA). Median time to pleurodesis in the historical cohort was 63 days (95% confidence interval 45, 86) when adjusted for ECOG performance status ≤ 2. Conclusions Vandetanib therapy was well tolerated; however it did not significantly reduce time to pleurodesis. PMID:24913066

  3. Metastatic renal cell carcinoma-associated pleural effusion after coronary artery bypass grafting.

    PubMed

    Rowlands, Deborah M; Zasik, Joseph M; Reed, James F

    2004-05-01

    Pleural effusions after coronary artery bypass grafting (CABG) occur in up to 89% of patients undergoing the procedure. Effusions present days to months after surgery, and fluid characteristics relate to timing factors. Most of the effusions are left-sided and resolve spontaneously. Pleural effusions requiring treatment occur in a small percentage of patients who have undergone CABG. Post-CABG pleural effusions in temporal relation to malignant effusions are not widely reported. This report describes a 50-year-old man presenting with a malignant left-sided pleural effusion 3 months after CABG, with characteristics resembling a late post-CABG effusion.

  4. Malignant pleural mesothelioma.

    PubMed

    Boutin, C; Schlesser, M; Frenay, C; Astoul, P

    1998-10-01

    The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.

  5. Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate?

    PubMed

    Avnon, L Sølling; Abu-Shakra, M; Flusser, D; Heimer, D; Sion-Vardy, N

    2007-08-01

    Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases. PMID:17294192

  6. Black Pleural Effusion: A Unique Presentation of Metastatic Melanoma

    PubMed Central

    Chhabra, Akansha; Mukherjee, Vikramjit; Chowdhary, Mudit; Danckers, Mauricio; Fridman, David

    2015-01-01

    Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis. PMID:26078741

  7. Black Pleural Effusion: A Unique Presentation of Metastatic Melanoma.

    PubMed

    Chhabra, Akansha; Mukherjee, Vikramjit; Chowdhary, Mudit; Danckers, Mauricio; Fridman, David

    2015-01-01

    Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis. PMID:26078741

  8. Reabsorption kinetics of albumin from pleural space of dogs

    SciTech Connect

    Miniati, M.; Parker, J.C.; Pistolesi, M.; Cartledge, J.T.; Martin, D.J.; Giuntini, C.; Taylor, A.E.

    1988-08-01

    The reabsorption of albumin from the pleural space was measured in eight dogs receiving 0.5 ml intrapleural injection of /sup 131/I-labeled albumin and a simultaneous intravenous injection of /sup 125/I-labeled albumin. Plasma curves for both tracers were obtained over 24 h. The /sup 125/I-albumin curve served as input function of albumin for interstitial spaces, including pleura, whereas the /sup 131/I-albumin curve represented the output function from pleural space. The frequency function of albumin transit times from pleural space to plasma was obtained by deconvolution of input-output plasma curves. Plasma recovery of /sup 131/I-albumin was complete by 24 h, and the mean transit time from pleura to plasma averaged 7.95 +/- 1.57 (SD) h. Albumin reabsorption occurred mainly via lymphatics as indicated by experiments in 16 additional dogs in which their right lymph ducts or thoracic ducts were ligated before intrapleural injection. A pleural lymph flow of 0.020 +/- 0.003 (SD) ml.kg-1.h-1 was estimated, which is balanced by a comparable filtration of fluid into the pleural space. This suggests that, under physiological conditions, the subpleural lymphatics represent an important control mechanism of pleural liquid pressure.

  9. Pleural, peritoneal and pericardial effusions – a biochemical approach

    PubMed Central

    Kopcinovic, Lara Milevoj; Culej, Jelena

    2014-01-01

    The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented. PMID:24627721

  10. [Current treatment strategy in malignant pleural effusion].

    PubMed

    Türler, A; Walter, M; Schmitz-Rixen, T

    1996-01-01

    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. PMID:8686317

  11. Thoracoscopic management of malignant pleural effusion.

    PubMed

    LoCicero, J

    1993-09-01

    The diagnosis and management of pleural effusions have been well recognized over the years as indications for thoracoscopy. New technology has enhanced its appeal. Video-assisted thoracic surgery is a well-tolerated procedure that affords excellent visualization of the entire pleural surface. Directed biopsies of suspicious areas lead to a high diagnostic yield, particularly when compared with percutaneous biopsies. New algorithms reflect this fact. Video-assisted thoracic surgery now follows diagnostic thoracentesis as the next step in the evaluation of effusion suspicious for malignancy. Video-assisted thoracic surgery can also aid the lysis of adhesions, which might limit the effectiveness of surgical procedures to produce pleurodesis, and is an ideal tool for therapeutic management. It may be performed with general anesthesia or local anesthesia and sedation. All of the pleural fluid can be removed and this facilitates the procedure. With minimal instrumentation, pleurodesis may be performed by pleurectomy, mechanical abrasion, or talc sclerosis. Visually directed placement of chest tubes ensures adequate reexpansion of the lung. PMID:8379759

  12. Pleurisy and Other Pleural Disorders

    MedlinePlus

    ... the layers of tissue is a very thin space called the pleural space. Normally this space is filled with a small amount of fluid— ... or gas can build up in the pleural space. When this happens, it's called a pneumothorax (noo- ...

  13. Protocol of the PLeural Effusion And Symptom Evaluation (PLEASE) study on the pathophysiology of breathlessness in patients with symptomatic pleural effusions

    PubMed Central

    Thomas, Rajesh; Azzopardi, Maree; Muruganandan, Sanjeevan; Read, Catherine; Murray, Kevin; Eastwood, Peter; Jenkins, Sue; Singh, Bhajan; Lee, Y C Gary

    2016-01-01

    Introduction Pleural effusion is a common clinical problem that can complicate many medical conditions. Breathlessness is the most common symptom of pleural effusion of any cause and the most common reason for pleural drainage. However, improvement in breathlessness following drainage of an effusion is variable; some patients experience either no benefit or a worsening of their breathlessness. The physiological mechanisms underlying breathlessness in patients with a pleural effusion are unclear and likely to be multifactorial with patient-related and effusion-related factors contributing. A comprehensive study of the physiological and symptom responses to drainage of pleural effusions may provide a clearer understanding of these mechanisms, and may identify predictors of benefit from drainage. The ability to identify those patients whose breathlessness will (or will not) improve after pleural fluid drainage can help avoid unnecessary pleural drainage procedures, their associated morbidities and costs. The PLeural Effusion And Symptom Evaluation (PLEASE) study is a prospective study to comprehensively evaluate factors contributing to pleural effusion-related breathlessness. Methods and analysis The PLEASE study is a single-centre prospective study of 150 patients with symptomatic pleural effusions that require therapeutic drainage. The study aims to identify key factors that underlie breathlessness in patients with pleural effusions and develop predictors of improvement in breathlessness following effusion drainage. Participants will undergo evaluation pre-effusion and post-effusion drainage to assess their level of breathlessness at rest and during exercise, respiratory and other physiological responses as well as respiratory muscle mechanics. Pre-drainage and post-drainage parameters will be collected and compared to identify the key factors and mechanisms that correlate with improvement in breathlessness. Ethics and dissemination Approved by the Sir Charles

  14. Collection and evaluation of equine peritoneal and pleural effusions.

    PubMed

    Cowell, R L; Tyler, R D; Clinkenbeard, K D; MacAllister, C G

    1987-12-01

    This article discusses collection, slide preparation, culture technique, fluid analysis and evaluation, and cytologic evaluation of peritoneal and pleural effusions. The morphologic characteristics of various effusions are described, and the physical characteristics (volume, color, turbidity) of effusions are discussed. An algorithm for classifying effusions as transudates, modified transudates, or exudates is included, and each category is discussed. PMID:3322526

  15. [Malignant Pleural Mesotheliomas].

    PubMed

    Biancosino, C; Redwan, B; Krüger, M; Eberlein, M; Bölükbas, S

    2016-09-01

    Malignant pleural mesotheliomas (MPM) are very aggressive tumors, which originate from the mesothelial cells of the pleural surface. The main risk factor associated with MPM is exposure to asbestos. The latency period between asbestos exposure and MPM can be 30-60 years. Clinical symptoms and signs are often nonspecifc. The diagnosis of MPM requires an adequate tissue specimen for pathological examination, and video assisted thoracoscopic surgey (VATS) is associated with the highest diagnostic yield. MPM are histologically classified into epitheloid, sacromatoid and biphasic (mixed) sub-types. Accurate staging with invasive tests, if needed, is an important step before an interdisciplinary team can decide on an optimal (multi-modal) treatment approach. A multi-modal treatment approach (surgery, radiation oncology and chemotherapy) is superior to all approaches relying only on a single modality, if the patient qualifies for it from an oncological and functional standpoint. The goal of the surgical therapy is to achieve macroscopic complete resection. There are two competing surgical approaches and philosophies: extrapleural pneumonectomy (EPP) and radical pleurectomy (RP). Over the last years a paradigm shift from EPP to RP occurred and RP is now often the preferred surgical option. PMID:27612329

  16. Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion

    PubMed Central

    Im, Kyong Shil; Choi, Min Kyung; Jeon, Yong Kyoung

    2016-01-01

    We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission. PMID:27499987

  17. Pleural mesothelial cells in pleural and lung diseases.

    PubMed

    Batra, Hitesh; Antony, Veena B

    2015-06-01

    During development, the mesoderm maintains a complex relationship with the developing endoderm giving rise to the mature lung. Pleural mesothelial cells (PMCs) derived from the mesoderm play a key role during the development of the lung. The pleural mesothelium differentiates to give rise to the endothelium and smooth muscle cells via epithelial-to-mesenchymal transition (EMT). An aberrant recapitulation of such developmental pathways can play an important role in the pathogenesis of disease processes such as idiopathic pulmonary fibrosis (IPF). The PMC is the central component of the immune responses of the pleura. When exposed to noxious stimuli, it demonstrates innate immune responses such as Toll-like receptor (TLR) recognition of pathogen associated molecular patterns as well as causes the release of several cytokines to activate adaptive immune responses. Development of pleural effusions occurs due to an imbalance in the dynamic interaction between junctional proteins, n-cadherin and β-catenin, and phosphorylation of adherens junctions between PMCs, which is caused in part by vascular endothelial growth factor (VEGF) released by PMCs. PMCs play an important role in defense mechanisms against bacterial and mycobacterial pleural infections, and in pathogenesis of malignant pleural effusion, asbestos related pleural disease and malignant pleural mesothelioma. PMCs also play a key role in the resolution of inflammation, which can occur with or without fibrosis. Fibrosis occurs as a result of disordered fibrin turnover and due to the effects of cytokines such as transforming growth factor-β, platelet-derived growth factor (PDGF), and basic fibroblast growth factor; which are released by PMCs. Recent studies have demonstrated a role for PMCs in the pathogenesis of IPF suggesting their potential as a cellular biomarker of disease activity and as a possible therapeutic target. Pleural-based therapies targeting PMCs for treatment of IPF and other lung diseases need

  18. Pleural mesothelial cells in pleural and lung diseases

    PubMed Central

    Antony, Veena B.

    2015-01-01

    During development, the mesoderm maintains a complex relationship with the developing endoderm giving rise to the mature lung. Pleural mesothelial cells (PMCs) derived from the mesoderm play a key role during the development of the lung. The pleural mesothelium differentiates to give rise to the endothelium and smooth muscle cells via epithelial-to-mesenchymal transition (EMT). An aberrant recapitulation of such developmental pathways can play an important role in the pathogenesis of disease processes such as idiopathic pulmonary fibrosis (IPF). The PMC is the central component of the immune responses of the pleura. When exposed to noxious stimuli, it demonstrates innate immune responses such as Toll-like receptor (TLR) recognition of pathogen associated molecular patterns as well as causes the release of several cytokines to activate adaptive immune responses. Development of pleural effusions occurs due to an imbalance in the dynamic interaction between junctional proteins, n-cadherin and β-catenin, and phosphorylation of adherens junctions between PMCs, which is caused in part by vascular endothelial growth factor (VEGF) released by PMCs. PMCs play an important role in defense mechanisms against bacterial and mycobacterial pleural infections, and in pathogenesis of malignant pleural effusion, asbestos related pleural disease and malignant pleural mesothelioma. PMCs also play a key role in the resolution of inflammation, which can occur with or without fibrosis. Fibrosis occurs as a result of disordered fibrin turnover and due to the effects of cytokines such as transforming growth factor-β, platelet-derived growth factor (PDGF), and basic fibroblast growth factor; which are released by PMCs. Recent studies have demonstrated a role for PMCs in the pathogenesis of IPF suggesting their potential as a cellular biomarker of disease activity and as a possible therapeutic target. Pleural-based therapies targeting PMCs for treatment of IPF and other lung diseases need

  19. Procalcitonin as a Diagnostic and Prognostic Factor for Tuberculosis Meningitis

    PubMed Central

    Kim, Jinseung; Kim, Si Eun; Park, Bong Soo; Shin, Kyong Jin; Ha, Sam Yeol; Park, JinSe; Kim, Sung Eun

    2016-01-01

    Background and Purpose We investigated the potential role of serum procalcitonin in differentiating tuberculosis meningitis from bacterial and viral meningitis, and in predicting the prognosis of tuberculosis meningitis. Methods This was a retrospective study of 26 patients with tuberculosis meningitis. In addition, 70 patients with bacterial meningitis and 49 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed among the three groups. In addition, we analyzed the predictive factors for a prognosis of tuberculosis meningitis using the Glasgow Coma Scale (GCS) at discharge, and the correlation between the level of procalcitonin and the GCS score at discharge. Results Multiple logistic regression analysis showed that a low level of procalcitonin (≤1.27 ng/mL) independently distinguished tuberculosis meningitis from bacterial meningitis. The sensitivity and specificity for distinguishing tuberculosis meningitis from bacterial meningitis were 96.2% and 62.9%, respectively. However, the level of procalcitonin in patients with tuberculosis meningitis did not differ significantly from that in patients with viral meningitis. In patients with tuberculosis meningitis, a high level of procalcitonin (>0.4 ng/mL) was a predictor of a poor prognosis, and the level of procalcitonin was negatively correlated with the GCS score at discharge (r=-0.437, p=0.026). Conclusions We found that serum procalcitonin is a useful marker for differentiating tuberculosis meningitis from bacterial meningitis and is also valuable for predicting the prognosis of tuberculosis meningitis. PMID:27165424

  20. Malignant pleural mesothelioma in a 17-year old boy: A case report and literature review

    PubMed Central

    Pérez-Guzmán, C.; Barrera-Rodríguez, R.; Portilla-Segura, J.

    2016-01-01

    Background Malignant pleural mesothelioma is a rare, invasive and often fatal neoplasm that develops in the thin layer of tissue surrounding the lungs known as the pleura. Although rare, mesotheliomas do occur in the young; their characteristics are distinct from those of older patients. Case presentation This is a case report of a 17-year-old boy who had moderate dyspnea, cough, right-sided pleuritic chest pain, fever, headache and no weight loss. Physical examination showed a right pleural effusion and chest roentgenograms revealed a homogenous opacity on lower right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic/turbid effusion compatible with exudate. It was initially treated as an empyema. The pleural fluid culture was negative. Adenosine deaminase level was 34.3 U/L (admission) and 19.02 U/L (two weeks after). Pleural fluid smear and culture for Mtb were negative. During the open pleural biopsy, thickened pleura and multiple pale yellow nodules in the lung were observed. The histopathological report was compatible with malignant pleural mesothelioma. With this diagnosis, a chemotherapy regimen with cisplatin was initiated. After two cycles, the patient had no clinical and radiological improvement. The patient is currently under regular follow up. Conclusion MPM is rare in young adults and its clinical presentation makes it different from mesothelioma in elderly patients, so it will be necessary to identify the new risk factors that can identify these patients. PMID:27222787

  1. Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

    PubMed Central

    Fysh, Edward T H; Thomas, Rajesh; Read, Catherine A; Lam, Ben C H; Yap, Elaine; Horwood, Fiona C; Lee, Pyng; Piccolo, Francesco; Shrestha, Ranjan; Garske, Luke A; Lam, David C L; Rosenstengel, Andrew; Bint, Michael; Murray, Kevin; Smith, Nicola A; Lee, Y C Gary

    2014-01-01

    Introduction Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management but requires hospitalisation (and substantial healthcare resources), can cause significant side effects, and has a suboptimal success rate. Indwelling pleural catheters (IPCs) allow ambulatory fluid drainage without hospitalisation, and are increasingly employed for management of malignant effusions. Previous studies have only investigated the length of hospital care immediately related to IPC insertion. Whether IPC management reduces time spent in hospital in the patients’ remaining lifespan is unknown. A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Methods and analysis The Australasian Malignant Pleural Effusion (AMPLE) trial is a multicentred, randomised trial designed to compare IPC with talc pleurodesis for the management of malignant pleural effusion. This study will randomise 146 adults with malignant pleural effusions (1:1) to IPC management or talc slurry pleurodesis. The primary end point is the total number of days spent in hospital (for any admissions) from treatment procedure to death or end of study follow-up. Secondary end points include hospital days specific to pleural effusion management, adverse events, self-reported symptom and quality-of-life scores. Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study as have the ethics boards of all the participating hospitals. The

  2. [Thoracoscopy in malignant pleural effusions].

    PubMed

    Zhang, D; Chen, Y; Tu, C

    1996-03-01

    To assess the value of thoracoscopy in malignant pleural effusions, the procedure and results of thoracoscopy by using a fiberoptic bronchoscope and a rigid cold-light thoracoscope in 130 cases with malignant pleural effusion are reported. The overall diagnostic rate was 91.5% (119/130). The malignant pleural mesothelioma in 24 cases and metastatic cancers in 95 cases were histopathologically confirmed. Talcum powder, tetracycline and Corynebacterium parvum were separately sprayed through thoracoscope into pleural cavity in 69, 10 and 10 patients, and the success rates of complete and lasting pleurodesis were 87.0%, 5/10 and 8/10 respectively. Postoperative complications included transient fever and chest pain, local subcutaneous emphysema in 6 cases and tumor seeding at thoracoscopy site in 4 cases. It is concluded that thoracoscopy is simple, safe, reliable and of high practical value in the diagnosis of malignant pleural effusions and in assessment before exploratory thoracotomy, and that transendoscopical administration of drugs for pleurodesis is a very effective method for controlling malignant pleural effusions. The efficacy of the talc poudrage is better than tetracycline and Corynebacterium parvum. PMID:9206045

  3. Yield of closed pleural biopsy and cytology in exudative pleural effusion

    PubMed Central

    Zuberi, Faisal Faiyaz; Zuberi, Bader Faiyaz; Ali, Syed Khalid; Hussain, Sagheer; Mumtaz, Farhana

    2016-01-01

    Objective: To determine diagnostic yield of Closed Pleural Biopsy (CPB) and Cytology in Exudative Pleural Effusion (PE). Methods: This prospective comparative study was conducted at Chest Unit-II & Medical Unit-IV of Dow University of Health Sciences, Karachi Pakistan from January 2011 till December 2014. Results: Ninety-four patients with exudative PE were finally included. The mean age (SD) was 44.0 (13.8) years. Overall Specific Diagnosis was reached in 76/94 patients; 46 Tuberculosis PE (TPE) & 30 Malignant PE (MPE). CPB diagnosed all TPE patients alone and 28/30 of MPE. Cytology diagnosed only 10/30 patients of MPE with 8 patients having both CPB & Cytology positive for malignancy whereas in the remaining two cases only Cytology positive. The sensitivity of CPB in detecting TPE and MPE was 93.9% and 82.4% respectively whereas specificity for both was 100%. The diagnostic yield of cytology in detecting MPE is only (33.3%). The diagnostic yield of CPB for TPE and MPE is 100% and 93.3% respectively. The overall specific diagnostic yield of CPB is 78.7%. Conclusion: CPB is better than pleural fluid cytology alone with the later adding little to diagnostic yield when both combined in distinguishing TPE from MPE, the two main differential of exudative PE in a TB-Endemic country. PMID:27182239

  4. Diagnostic Accuracy of Procalcitonin in Bacterial Meningitis Versus Nonbacterial Meningitis

    PubMed Central

    Wei, Ting-Ting; Hu, Zhi-De; Qin, Bao-Dong; Ma, Ning; Tang, Qing-Qin; Wang, Li-Li; Zhou, Lin; Zhong, Ren-Qian

    2016-01-01

    Abstract Several studies have investigated the diagnostic accuracy of procalcitonin (PCT) levels in blood or cerebrospinal fluid (CSF) in bacterial meningitis (BM), but the results were heterogeneous. The aim of the present study was to ascertain the diagnostic accuracy of PCT as a marker for BM detection. A systematic search of the EMBASE, Scopus, Web of Science, and PubMed databases was performed to identify studies published before December 7, 2015 investigating the diagnostic accuracy of PCT for BM. The quality of the eligible studies was assessed using the revised Quality Assessment for Studies of Diagnostic Accuracy method. The overall diagnostic accuracy of PCT detection in CSF or blood was pooled using the bivariate model. Twenty-two studies involving 2058 subjects were included in this systematic review and meta-analysis. The overall specificities and sensitivities were 0.86 and 0.80 for CSF PCT, and 0.97 and 0.95 for blood PCT, respectively. Areas under the summary receiver operating characteristic curves were 0.90 and 0.98 for CSF PCT and blood PCT, respectively. The major limitation of this systematic review and meta-analysis was the small number of studies included and the heterogeneous diagnostic thresholds adopted by eligible studies. Our meta-analysis shows that PCT is a useful biomarker for BM diagnosis. PMID:26986140

  5. Two cases of paragonimiasis westermani diagnosed after eosinophilic pleural effusion-induced hydropneumothorax.

    PubMed

    Yaguchi, Daizo; Ichikawa, Motoshi; Kobayashi, Daisuke; Inoue, Noriko; Shizu, Masato; Imai, Naoyuki

    2016-05-01

    Our hospital is located in the Tono region in the southeastern district of Gifu Prefecture in which there are forests and inhabitants who still hunt and eat game meat. Therefore, boar meat increases the risk of contracting paragonimiasis. We treated two patients who were infected by Paragonimus westermani after eating boar meat. They developed hydropneumothorax in association with eosinophilic pleural effusion. For patients who have pneumothorax with concomitant pleural effusion and eosinophilia in the pleural fluid analysis, it is necessary to take a detailed history, which includes flesh food consumption and travel to an endemic area, and to make a careful examination while taking into consideration parasitic infections such as paragonimiasis. PMID:27516883

  6. Pleuritis and pleural effusion in the horse: a study of 37 cases.

    PubMed

    Smith, B P

    1977-01-15

    Pleural effusion in 37 horses, including 15 acutely affected and 22 chronically affected, was found to be due to a variety of causes, including lymphocarcoma, pulmonary granulomas, coccidioidomycosis, equine infectious anemia, pulmonary abscesses, chronic pneumonia, and primary septic pleural effusion. Age, breed, or sex predilection was not found. Horses with chronic disease had weight loss, increased respiratory rate, dull respiratory sounds in the ventral portion of the thorax, and varying degrees of anorexia. Many horses were anemic. Those acutely affected had respiratory distress or signs of colic and many were anorectic. Most horses with acute primary disease had small volumes of pleural fluid. Culture and cytologic examination of pleural fluid and tracheal washings revealed the causative organism in some instances, but in a number of "primary" cases there were negative results on bacterial culture. The latter cases must be differentiated from other causes of chronic weight loss in the horse. PMID:576221

  7. Malignant pleural mesothelioma.

    PubMed

    Ho, L; Sugarbaker, D J; Skarin, A T

    2001-01-01

    Malignant pleural mesothelioma remains a difficult tumor to treat, much less cure. Currently, the best chance for long-term survival lies with early diagnosis and aggressive surgical extirpation, but given the typically long delay between the onset of symptoms and diagnosis, this is only possible with a high index of suspicion and an aggressive diagnosis workup. Early referral to a tertiary center experienced in the treatment of MPM may be important for several reasons: (1) decreased risk of tumor spread along multiple thoracenesis/biopsy tracts, (2) the availability of specialized pathologic assays for definitive diagnosis, (3) the availability of critical staging modalities (aggressive mediastinoscopy +/- thoracoscopy, MRI scans performed according to specific mesothelioma protocols, and perhaps PET scans), (4) surgical experience with pleurectomy/decortication and/or extrapleural pneumonectomy, that may decrease morbidity and mortality, and (5) the availability of novel adjuvant protocols. Single-modality therapy is unlikely to result in long-term survival. Aggressive surgery is required for optimal debulking, and extrapleural pneumonectomy may offer better local control compared with pleurectomy/ecortication. Delivery of optimal radiation schedules, which may involve large fractions as well as large total doses, is limited by the presence of nearby dose-limiting structures. Current chemotherapy is severely lacking in producing objective responses and improved survival although gemcitabine and IL-2 may be active agents to be combined with radiation and/or other agents. Hyperthermia, photodynamic therapy, intracavitary therapy, and gene therapy are all relatively new techniques under active investigation that should be supported by enrollment in on-going protocols. Predictably, many of these techniques provide greater benefit when used in the setting of adjuvant protocols or minimal residual disease, emphasizing the importance of multimodality therapy.

  8. Hemorrhagic sarcoid pleural effusion: A rare entity

    PubMed Central

    Jha, Onkar; Nair, Vidya; Talwar, Deepak

    2016-01-01

    Involvement of pleura by sarcoidosis remains a rare manifestation and varies from pleural effusion, pneumothorax, pleural thickening, hydropneumothorax, trapped lung, hemothorax, or chylothorax. Sarcoid pleural effusions presenting as hemorrhagic effusions are even more rare. We report a case of active pulmonary sarcoidosis presenting as hemorrhagic pleural effusion requiring tissue diagnosis to rule out malignancy. The rarity of the presentation prompted us to report this case. PMID:27625449

  9. Hemorrhagic sarcoid pleural effusion: A rare entity

    PubMed Central

    Jha, Onkar; Nair, Vidya; Talwar, Deepak

    2016-01-01

    Involvement of pleura by sarcoidosis remains a rare manifestation and varies from pleural effusion, pneumothorax, pleural thickening, hydropneumothorax, trapped lung, hemothorax, or chylothorax. Sarcoid pleural effusions presenting as hemorrhagic effusions are even more rare. We report a case of active pulmonary sarcoidosis presenting as hemorrhagic pleural effusion requiring tissue diagnosis to rule out malignancy. The rarity of the presentation prompted us to report this case.

  10. Hemorrhagic sarcoid pleural effusion: A rare entity.

    PubMed

    Jha, Onkar; Nair, Vidya; Talwar, Deepak

    2016-01-01

    Involvement of pleura by sarcoidosis remains a rare manifestation and varies from pleural effusion, pneumothorax, pleural thickening, hydropneumothorax, trapped lung, hemothorax, or chylothorax. Sarcoid pleural effusions presenting as hemorrhagic effusions are even more rare. We report a case of active pulmonary sarcoidosis presenting as hemorrhagic pleural effusion requiring tissue diagnosis to rule out malignancy. The rarity of the presentation prompted us to report this case. PMID:27625449

  11. Early dislodgement of Indwelling Pleural Catheter (IPC): a balancing act

    PubMed Central

    Tung, Alvin Hon Man; Ngai, Jenny Chun Li; Ng, Susanna So Shan; Ko, Fanny Wai San; Hui, David Shu-Cheong

    2014-01-01

    A 63-year-old nonsmoker with right malignant pleural effusion derived symptomatic benefit following drainage of his effusion. Following insertion of indwelling pleural catheter (IPC), 1.3 L of blood-stained fluid was drained into underwater sealed bottle (Atrium®), but the IPC dislodged 26 h after continuous connection. We believe that the weight of the drainage bottle (including the un-emptied fluid) and the prolonged connection time contributed to this uncommon event reported in the literature. There was no recurrence when his second IPC was connected to a drainage bag which was emptied at every 500 mL, capped at 2 h each time. An anchoring stitch should also be considered when drainage devices heavier than the manufacturer bottles are used to drain IPC. PMID:25473551

  12. Primary malignant myelomatous pleural effusion.

    PubMed

    Mangla, Ankit; Agarwal, Nikki; Kim, George J; Catchatourian, Rosalind

    2016-08-01

    Primary malignant myelomatous pleural effusion (PMMPE) occurs in less than 1% of patients with multiple myeloma and is diagnosed either by visualization of plasma cells on cytology or by positive flow cytometry. The presence of immature plasma cells characterized by high nucleus to cytoplasm ratio, visible nucleolus and presence of Mott cells and Russell bodies are independent poor prognostic factors. The clinician should differentiate PMMPE from secondary pleural effusion as it is associated with a significantly worse prognosis and poor overall survival. PMID:27525090

  13. [Procalcitonin, a new marker for bacterial infections].

    PubMed

    Ferrière, F

    2000-01-01

    Procalcitonin (PCT), the precursor protein of the hormone calcitonin, appears to be an early marker of the presence of severe systemic infection. High serum concentrations are associated with severe systemic bacterial, parasitic or fungal infections. In contrast, PCT is generally not induced by severe viral infections or inflammatory reactions of non-infectious origin. Hence, PCT can be used for differential diagnosis of bacterial and viral meningitis. PCT may be helpful in the differentiation between infectious and non-infectious origin of systemic inflammatory response syndrome (SIRS) and acute respiratory distress syndrome (ARDS), pancreatitis, cardiogenic shock and acute rejection of organ transplants. PCT monitoring may be useful in patients with high risk of bacterial infection (major surgery, trauma, immunocompromised patients). PCT is a very stable molecule in vitro, and its measurement requires only 20 ml of plasma or serum and can be done within 2 hours.

  14. Effect of intrabronchially instilled amosite on lavagable lung and pleural cells.

    PubMed Central

    Oberdoerster, G; Ferin, J; Marcello, N L; Meinhold, S H

    1983-01-01

    Rats were instilled intrabronchially with 1 mg UICC amosite suspended in 0.2 mL of filtered saline; control animals received the saline instillation only. Five animals from each group were killed on various days after instillation, up to day 128/129. Total retrieved cell counts and differential cell analysis were performed from lung and pleural lavages. In particular, the appearance of peroxidase-positive macrophages (PPM) as indicators of newly arrived macrophages was investigated. Polymorphonuclear cells (PMN) and PPMs in lung lavages increased in number 24 hr after amosite instillation and remained at increased levels until day 62. Alveolar macrophage numbers were significantly decreased after amosite instillation. There was only a very transient increase of PPMs and PMNs in the saline group. The number of PPMs in pleural lavage fluid was already increased 24 hr after amosite instillation. The pleural PPM increase was sustained throughout the study. No pleural reaction was seen in the saline instilled group. The inflammatory reactions indicated by the composition of the lavaged cells of the lung represent the in vivo toxicity of intrabronchially instilled amosite. The stimulus for recruitment of PMNs and PPMs is different, since no PMN response was detected in the pleural space. It is suggested that the response of the pleural PPMs is caused by the early arrival of fibers at the pleural sites, which results in the recruitment of PPMs to this space by an unknown mechanism. PMID:6315380

  15. Predictive values for procalcitonin in the diagnosis of neonatal sepsis

    PubMed Central

    Mohsen, Abdel Hakeem Abdel; Kamel, Bothina Ahmed

    2015-01-01

    Background: Early diagnosis of neonatal sepsis followed by appropriate treatment decreases mortality and morbidity in infants. The aim of this study is to assess the role of procalcitonin (PCT) as a marker in the early diagnosis of neonatal sepsis. Methods: We present a cross sectional study where 35 neonates with early onset sepsis (admitted to the Neonatal Intensive Care Units at El-Minia Children University Hospital from August 2012 to August 2013) were included in the study. Another 35 healthy neonates with no clinical or biological data of infection were included as a control group. Subjects were subjected to a thorough history taking and routine laboratory investigations. Serum PCT and C-reactive protein (CRP) levels were determined by enzyme-linked immunosorbent assay (ELISA). Results: Mean levels of PCT and CRP in neonates with sepsis were significantly higher than in the control group (p=0.0001). There was a moderate, but significant, positive correlation between PCT and C-reactive protein (p=0.001, r=0.55) and an insignificant correlation between procalcitonin and total leukocytic count among the neonates with sepsis (p=0.2, r=0.2). In addition, procalcitonin had high sensitivity, specificity, a high positive predictive value, and a high negative predictive value (80%, 85.7%, 84.8%, and 81.1% respectively). Procalcitonin showed higher sensitivity when compared to CRP. Conclusion: Procalcitonin is a sensitive, independent, and useful biomarker in comparison to CRP in early diagnosis of neonatal sepsis. PMID:26396733

  16. Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion

    PubMed Central

    Kim, Jeong Eun; Lee, Chul; Park, Kook In; Park, Min Soo; Park, In Kyu

    2012-01-01

    OK-432 (picibanil) is an inactivated preparation of Streptococcus pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome. PMID:22670153

  17. Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion.

    PubMed

    Kim, Jeong Eun; Lee, Chul; Park, Kook In; Park, Min Soo; Namgung, Ran; Park, In Kyu

    2012-05-01

    OK-432 (picibanil) is an inactivated preparation of Streptococcus pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.

  18. Iodized talc pleurodesis for the treatment of pleural effusions.

    PubMed

    Webb, W R; Ozmen, V; Moulder, P V; Shabahang, B; Breaux, J

    1992-05-01

    This prospective study was designed to determine the efficacy of iodized talc pleurodesis in patients with pleural effusions. Thirty-four patients underwent this treatment (three bilaterally) between October 1, 1989, and March 31, 1991. All patients had to have complete or nearly complete lung reexpansion after tube thoracostomy with fluid drainage less than 100 ml in 24 hours. A slurry containing 5 gm of talc and 3 gm of thymol iodide was instilled into the pleural space through the chest tube. Chest tubes were removed after complete reexpansion and clearing of the effusions, usually in 3 to 5 days. The patients' ages ranged from 26 to 88 years (average 50 years). Eighteen patients had lung carcinoma, two had mesothelioma, and one each had carcinoma of the ovary, breast, or anorectum, multiple myeloma, schwannoma, or Hodgkin's lymphoma. Two patients had an unknown adenocarcinoma primary and five other patients had acquired immunodeficiency syndrome. One patient had congestive heart failure. Nineteen patients had left, 12 had right, and three had bilateral pleural effusions. The effusion was serosanguineous in 26 and serofibrinous in eight patients. Serial chest radiography showed complete response in all patients. The period of follow-up ranged from 1 to 21 (average 4.9) months, with no recurrences. Twenty-three patients have died during the follow-up period, and there was no sign that reaccumulated pleural effusion existed in any, despite clinical evidence of systemic tumor progression. These observations indicate that intrapleural instillation of a slurry of iodized talc is a safe, adequate, and effective treatment for control of neoplastic or benign pleural effusions.

  19. Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema

    PubMed Central

    Suárez, Pedro Rodríguez; Gilart, Jorge Freixinet; Pérez, José María Hernández; Serhal, Mohamed Hussein; Artalejo, Antonio López

    2012-01-01

    Summary Background We performed this observational prospective study to evaluate the results of the application of a diagnostic and therapeutic algorithm for complicated parapneumonic pleural effusion (CPPE) and pleural parapneumonic empyema (PPE). Material/Methods From 2001 to 2007, 210 patients with CPPE and PPE were confirmed through thoracocentesis and treated with pleural drainage tubes (PD), fibrinolytic treatment or surgical intervention (videothoracoscopy and posterolateral thoracotomy). Patients were divided into 3 groups: I (PD); II (PD and fibrinolytic treatment); IIIa (surgery after PD and fibrinolysis), and IIIb (direct surgery). The statistical study was done by variance analysis (ANOVA), χ 2 and Fisher exact test. Results The presence of alcohol or drug consumption, smoking and chronic obstructive pulmonary disease (COPD) were strongly associated with a great necessity for surgical treatment. The IIIa group was associated with increased drainage time, length of stay and complications. No mortality was observed. The selective use of PD and intrapleural fibrinolysis makes surgery unnecessary in more than 75% of cases. Conclusions The selective use of PD and fibrinolysis avoids surgery in more than 75% of cases. However, patients who require surgery have more complications, longer hospital stay, and more days on PD and they are more likely to require admittance to the Intensive Care Unit. PMID:22739734

  20. Pleural controversy: optimal chest tube size for drainage.

    PubMed

    Light, Richard W

    2011-02-01

    In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. The advantages of the small-bore catheters are that they are easier to insert and there is less pain with their insertion while they are in place. The placement of the small-bore catheters is probably more optimal when placement is done with ultrasound guidance. Small-bore chest tubes are recommended when pleurodesis is performed. The success of the small-bore indwelling tunnelled catheters that are left in place for weeks documents that the small-bore tubes do not commonly become obstructed with fibrin. Patients with complicated parapneumonic effusions are probably best managed with small-bore catheters even when the pleural fluid is purulent. Patients with haemothorax are best managed with large-bore catheters because of blood clots and the high volume of pleural fluid. Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes.

  1. Pleural effusion resulting from malignant hepatoblastoma in a horse.

    PubMed

    Prater, P E; Patton, C S; Held, J P

    1989-02-01

    Pleural effusion, secondary to a metastasis from a malignant hepatoblastoma, was diagnosed in a 3-year-old Appaloosa gelding. Severe hemorrhagic transudate in both pleural cavities resulted in acute onset of labored breathing, tachypnea, tachycardia, and jugular vein pulsation. Results of ultrasonography and radiography of the ventral lung field and cranial portion of the abdomen initially were nondiagnostic, as were results of cytologic examination of peritoneal fluid and tracheal wash specimens. Moderately high serum gamma-glutamyl transferase and alkaline phosphatase activities, despite normal hepatocyte-specific enzyme (sorbital dehydrogenase) activity, were indicative of biliary stasis without hepatocyte destruction. The horse was euthanatized. Necropsy revealed a 47-kg hepatoblastoma, with metastases in the lungs and intestines. PMID:2537279

  2. Pleural effusion in a neonate

    PubMed Central

    Shetty, Sandeep Krishnanand; Butler, Mark

    2011-01-01

    A premature neonate who developed respiratory distress in the first few days of life was found to have a pleural effusion, which reaccumulated following drainage. The effusion was demonstrated to be a chylothorax. He required multiple chest drains and was started on a medium chain triglyceride formula feed. This brought about a full resolution of the effusions and he made a complete recovery. PMID:22688472

  3. [Serum procalcitonin and respiratory tract infections].

    PubMed

    Zarka, V; Valat, C; Lemarié, E; Boissinot, E; Carré, P; Besnard, J C; Diot, P

    1999-12-01

    The aim of our study was to evaluate the prognostic value of serum procalcitonine (PCT) assay in adult respiratory infections. Forty-nine patients admitted with pleurisy, community-acquired pneumonia, tuberculosis, infection were included in this prospective study. PCT was assayed on admission and discharge. Biological and clinical parameters of gravity were also evaluated. Twenty patients had elevated PCT of more than 0.50 ng/ml. In 29 patients, PCT was undetectable. The serum PCT level was normal in the patients with tuberculosis, infection, pneumocytosis. PCT did not correlate with the biological and clinical markers of the disease severity but the evolution of PCT correlated with the evolution of C-reactive-protein (r = 0.58, p < 0.05). PCT seems to be an early marker of the evolution of respiratory infections, but it does not help to establish prognosis. Further studies are necessary to assess the potential value of PCT in more severe respiratory infections requiring assisted ventilation. PMID:10685471

  4. Asbestos-related benign pleural disease.

    PubMed

    Peacock, C; Copley, S J; Hansell, D M

    2000-06-01

    Benign pleural disease is the commonest manifestation of asbestos exposure encountered by radiologists. Benign pleural thickening can appear as circumscribed parietal pleural plaques or as more diffuse thickening of the visceral pleura. Benign-asbestos induced pleural effusions are a significant and under-recognized manifestation of asbestos exposure with important sequelae, such as diffuse pleural thickening which may be associated with functional impairment and for which compensation may be sought. This review concentrates on the strengths and weaknesses of chest radiography and computed tomography for the detection and characterization of benign asbestos-related pleural disease and the relevance of imaging abnormalities to compensation and functional impairment.Peacock, C. (2000). Clinical Radiology55, 422-432. PMID:10873686

  5. Pleural calcification in northwest Greece

    SciTech Connect

    Bazas, T.; Oakes, D.; Gilson, J.C.; Bazas, B.; McDonald, J.C.

    1985-12-01

    Mass miniature radiography in 1969 detected a high prevalence of pleural calcification in three villages in northwest Greece. In 1980 a survey of a 15% sample of the population over the age of 10 was carried out with a 80% response rate. Full-size radiographs, ventilatory capacity measurements, and a detailed questionnaire on respiratory symptoms, type of work, and residence were used. Independent classification of the 408 films by two readers using the ILO/UC scheme showed very few small opacities but a very high prevalence of pleural calcification first evident in young adults and rising to 70% in the elderly. The overall prevalence was 34.7% in men and 21.5% in women. A comparison with the 1969 survey showed a progression rate of 5% per annum. In neither sex was there a significant relation of pleural calcification to smoking, ventilatory capacity, nor type of work, though those classified as field croppers had a slightly higher prevalence. There was no obvious evidence of increased lung cancer or mesothelioma in the village. The agent responsible for this apparently benign condition was not identified.

  6. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia

    PubMed Central

    Huang, David T.; Weissfeld, Lisa A.; Kellum, John A.; Yealy, Donald M.; Kong, Lan; Martino, Michael; Angus, Derek C.

    2009-01-01

    Objective The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia (CAP), but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in CAP. Our objective was to describe the pattern of procalcitonin in CAP, and determine if procalcitonin provides prognostic information beyond PSI and CURB-65. Methods We conducted a multi-center prospective cohort study in 28 community and teaching emergency departments. Patients presenting with a clinical and radiographic diagnosis of CAP were enrolled. We stratified procalcitonin levels a priori into four tiers – I: < 0.1; II: ≥ 0.1 to <0.25; III: ≥ 0.25 to < 0.5; and IV: ≥ 0.5 ng/ml. Primary outcome was 30d mortality. Results 1651 patients formed the study cohort. Procalcitonin levels were broadly spread across tiers: 32.8% (I), 21.6% (II), 10.2% (III), 35.4% (IV). Used alone, procalcitonin had modest test characteristics: specificity (35%), sensitivity (92%), positive likelihood ratio (LR) (1.41), and negative LR (0.22). Adding procalcitonin to PSI in all subjects minimally improved performance. Adding procalcitonin to low risk PSI subjects (Class I–III) provided no additional information. However, subjects in procalcitonin tier I had low 30d mortality regardless of clinical risk, including those in higher risk classes (1.5% vs. 1.6% for those in PSI Class I–III vs. Class IV/V). Among high risk PSI subjects (Class IV/V), one quarter (126/546) were in procalcitonin tier I, and the negative LR of procalcitonin tier I was 0.09. Procalcitonin tier I was also associated with lower burden of other adverse outcomes. Similar results were seen with CURB-65 stratification. Conclusions Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients. PMID:18342993

  7. Yellow nails, lymphedema and pleural effusion. Treatment of chronic pleural effusion with pleuroperitoneal shunting.

    PubMed

    Brofman, J D; Hall, J B; Scott, W; Little, A G

    1990-03-01

    Pleural effusion secondary to lymphedema may be chronic, symptomatic and refractory to treatment, occasionally requiring invasive and painful procedures such as chemical pleurodesis, open pleural abrasion or pleurectomy to achieve control of the effusion and gain symptomatic relief. We report a patient with yellow nail syndrome and chronic pleural effusion successfully treated with pleuroperitoneal shunting.

  8. Diagnostic value of procalcitonin in acutely hospitalized elderly patients.

    PubMed

    Steichen, O; Bouvard, E; Grateau, G; Bailleul, S; Capeau, J; Lefèvre, G

    2009-12-01

    The aim of this study was to evaluate procalcitonin as an adjunct to diagnose bacterial infections in older patients. One hundred seventy-two patients admitted to an acute-care geriatric unit during a 6-month period were prospectively included, 39 of them with an invasive bacterial infection. The best cut-off value to rule in a bacterial infection was 0.51 microg/l with sensitivity 64% and specificity 94%. The best cut-off value to rule out a bacterial infection was 0.08 microg/l with sensitivity 97% and specificity 20%. Procalcitonin was inconclusive (between 0.08 and 0.51 microg/l) for 112 admissions. Procalcitonin over 0.51 microg/l was useless 22 times out of 33 (infection already ruled in on clinical grounds) and misleading in eight of the 11 remaining cases (no infection). Procalcitonin below 0.08 microg/l was useless 23 times out of 27 (infection already ruled out on clinical grounds) and misleading in one of the four remaining cases (infection). Despite a good overall diagnostic accuracy, the clinical usefulness of PCT to diagnose invasive bacterial infections in elderly patients hospitalized in an acute geriatric ward appears to be very limited. PMID:19727867

  9. [ANALYSIS OF MICROFLORA OF PLEURAL CAVITY IN PLEURAL EMPYEMA].

    PubMed

    Chubar, I V

    2016-04-01

    In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost.

  10. [ANALYSIS OF MICROFLORA OF PLEURAL CAVITY IN PLEURAL EMPYEMA].

    PubMed

    Chubar, I V

    2016-04-01

    In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost. PMID:27434955

  11. Pleural effusion secondary to thoracic metastatic mammary adenocarcinoma in a mare.

    PubMed

    Foreman, J H; Weidner, J P; Parry, B W; Hargis, A

    1990-11-01

    A 17-year-old Quarter Horse mare was examined nearly 3 years after excision and cryotherapy of a papillary mammary gland adenocarcinoma. The mare had been used for pleasure riding since surgery, but had recently developed progressive dyspnea. The mare had clinical evidence of pleural effusion, but died before further clinical examination and treatment were instituted. Necropsy revealed deep mammary masses with similar nodules in the deep inguinal, renal, and mediastinal lymph nodes and in the lungs, pericardium, visceral and parietal pleurae, and left ovary. The masses were identified as papillary mammary gland adenocarcinoma. Large volumes of free pleural and peritoneal fluid were detected. The pleural fluid contained similar neoplastic cells that could have been readily detected by exfoliative cytologic examination had the mare survived. PMID:2254151

  12. Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis.

    PubMed

    Dias, Brendan Hermenigildo; Rozario, Anthony Prakash; Olakkengil, Santosh Antony; V, Anirudh

    2015-12-01

    Plasma procalcitonin (PCT) is a highly specific marker for the diagnosis of bacterial infection and sepsis. Studies have demonstrated its role in the setting of sepsis and acute pancreatitis. This study aims to analyze and compare the prognostic efficacy of plasma procalcitonin strip test in acute pancreatitis. A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma procalcitonin was estimated by the semiquantitative strip test. The study included a total of 50 patients diagnosed to have acute pancreatitis. Data was collected and statistically analyzed using SPSS version 17. Thirty-nine out of the 50 patients (78 %) were males with a mean age of 46.8 years (range, 25-78 years) and 25 patients (50 %) had ethanol-induced pancreatitis, while 13 patients (26 %) had gall stone pancreatitis. Plasma PCT values were found to correlate better than CRP levels and total leukocyte count with the total duration of hospitalization, ITU, and ICU stay, as well as with the progression to severe acute pancreatitis. A cut off for plasma PCT of >2 ng/mL was found to be 100 % sensitive and 100 % specific and a cut off for CRP of >19 mg/dL was 70 % sensitive and 65 % specific for predicting the progression to severe acute pancreatitis. Plasma PCT also correlated well with antibiotic requirement. A cut off value of >0.5 ng/mL for plasma PCT was 100 % sensitive and 80 % specific and a cut off value of >18 mg/dL for CRP was 86 % sensitive and 63 % specific for predicting antibiotic requirement. Plasma procalcitonin is an early and reliable prognostic indicator in acute pancreatitis. The procalcitonin strip test is a rapid test which is useful in analyzing prognosis in patients with acute pancreatitis. PMID:27011501

  13. Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis.

    PubMed

    Dias, Brendan Hermenigildo; Rozario, Anthony Prakash; Olakkengil, Santosh Antony; V, Anirudh

    2015-12-01

    Plasma procalcitonin (PCT) is a highly specific marker for the diagnosis of bacterial infection and sepsis. Studies have demonstrated its role in the setting of sepsis and acute pancreatitis. This study aims to analyze and compare the prognostic efficacy of plasma procalcitonin strip test in acute pancreatitis. A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma procalcitonin was estimated by the semiquantitative strip test. The study included a total of 50 patients diagnosed to have acute pancreatitis. Data was collected and statistically analyzed using SPSS version 17. Thirty-nine out of the 50 patients (78 %) were males with a mean age of 46.8 years (range, 25-78 years) and 25 patients (50 %) had ethanol-induced pancreatitis, while 13 patients (26 %) had gall stone pancreatitis. Plasma PCT values were found to correlate better than CRP levels and total leukocyte count with the total duration of hospitalization, ITU, and ICU stay, as well as with the progression to severe acute pancreatitis. A cut off for plasma PCT of >2 ng/mL was found to be 100 % sensitive and 100 % specific and a cut off for CRP of >19 mg/dL was 70 % sensitive and 65 % specific for predicting the progression to severe acute pancreatitis. Plasma PCT also correlated well with antibiotic requirement. A cut off value of >0.5 ng/mL for plasma PCT was 100 % sensitive and 80 % specific and a cut off value of >18 mg/dL for CRP was 86 % sensitive and 63 % specific for predicting antibiotic requirement. Plasma procalcitonin is an early and reliable prognostic indicator in acute pancreatitis. The procalcitonin strip test is a rapid test which is useful in analyzing prognosis in patients with acute pancreatitis.

  14. Distant visceral metastases in pleural mesothelioma.

    PubMed

    Roberts, G H

    1976-10-01

    Distant visceral metastases were found in 15 of 32 cases of pleural mesothelioma (47%). Contrary to earlier reports pleural mesothelioma should be regarded as a tumour in which visceral metastases are not uncommon. No association was found between the histological type of mesothelioma and visceral metastases; the peritoneal involvement found in five cases is probably due to local infiltration and seeding.

  15. [Cytologic diagnosis of pleural mesothelioma].

    PubMed

    Kirdan, G V; Biriukov, Iu V; Nikolaeva, E P

    1990-08-01

    The efficacy of examination of various cytologic material in patients with mesothelioma was analysed. A total of 48 studies were carried out in 24 patients. Examination of transthoracic aspiration material obtained from the tumor and pleural cavity exudate yielded the best results. When mesothelioma of the pleura is suspected, care should be taken to collect material from different areas of the tumor, bearing in mind the significance of discovering different components of the tumor in it. On grounds of study of various cytologic material, a malignant tumor or adenocarcinoma was diagnosed in 43% and mesothelioma in 48% of patients.

  16. Clinical value of CYFRA21-1, NSE, CA15-3, CA19-9 and CA125 assay in the elderly patients with pleural effusions.

    PubMed

    Li, C-S; Cheng, B-C; Ge, W; Gao, J-F

    2007-03-01

    The aim of this study was to evaluate the individual and combined diagnostic value of five tumour markers in the elderly patients with pleural effusions. Serum and pleural fluid levels of cytokeratin fragment 19 (CYFRA21-1), neuron-specific enolase (NSE), carbohydrate antigen 15-3 (CA15-3), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125) were assayed in 32 elderly patients with malignant pleural effusions resulting from advanced lung cancer and in 30 elderly patients with benign pleural effusions by ELISA. Serum levels of CYFRA21-1, NSE, CA15-3, CA19-9 and CA125 in patients with malignant pleural effusions were 12.84 +/- 6.48 microg/l, 22.07 +/- 11.25 microg/l, 65.74 +/- 30.26 kU/l, 56.32 +/- 25.6 kU/l and 71.86 +/- 31.45 kU/l, respectively, and were significantly higher than those in patients with benign pleural effusions (p < 0.01). Pleural fluid levels of CYFRA21-1, CA15-3, CA19-9 and CA125 except NSE in patients with malignant pleural effusions were 18.64 +/- 8.15 microg/l, 59.31 +/- 27.35 kU/l, 48.24 +/- 21.56 kU/l and 62.16 +/- 27.79 kU/l, respectively, and were significantly higher than those in patients with benign pleural effusions (p < 0.01). The parallel combined testing of five tumour markers in serum increased the diagnostic sensitivity to 90.6%, and serial combined testing increased the diagnostic specificity to 93.3%. The sensitivity (%) and specificity (%) of these tumour markers in pleural fluid were as follows: CYFRA21-1, 84.4/90; CA15-3, 62.5/73.3; CA19-9, 37.5/66.7; CA125, 56.3/70; for differentiating malignant effusions from benign effusions. When CYFRA21-1 and CA15-3 combined, the sensitivity and specificity were increased (100% and 90% respectively). Serum and pleural fluid levels of the five tumour markers shows certain values in the diagnosis and differentiate diagnosis for malignant pleural effusions in the elderly patients from benign. The combined assay of five tumour markers in serum and the CYFRA21-1 combined

  17. Intrapleural Corynebacterium parvum for recurrent malignant pleural effusions.

    PubMed

    Foresti, V

    1995-01-01

    Twenty-two consecutive patients with malignant pleural effusions (MPE) were treated with intrapleural Corynebacterium parvum (CBP) associated with parenteral methylprednisolone (MP) to determine its effectiveness and the frequency and nature of adverse reactions. After thoracentesis, 7 mg of CBP (Coparvax Wellcome) in 20 ml of saline were injected into the pleural cavity. On the day of treatment, the patients were given 1 mg/kg i.m. of MP 30 min before thoracentesis. The effectiveness of pleurodesis was assessed as follows: (1) complete response (CR; total resolution of pleural effusion after 3 injections of CBP at the most); (2) partial response (PR; formation of asymptomatic loculated effusion). In 5 patients leukocytes, lymphocytes and monocytes were determined in pleural fluid (PF) and in blood (B) collected before and 7 days after CBP treatment. Two patients were unevaluable. Of 20 evaluable patients, 18 (90%) had a CR and 2 patients (10%) had a PR. Eleven of 22 patients (50%) had a fever. Three patients had prolonged and/or high fever. Seven of 22 patients (32%) had mild chest pain. None of the patients presented other side effects. Twelve of 21 patients (57.1%) had a PF pH > or = 7.30; 2 of these died a few days after the treatment, and 10 had favorable responses. The other 9 patients had a PF pH < 7.30: all had favorable responses. The leukocytes, the lymphocyte subsets, the monocytes, the NK lymphocytes, and their PF/B ratios did not differ significantly before and after CBP treatment. Our study confirms that intrapleural CBP is an effective and simple method to control MPE.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7716350

  18. Malignant pleural mesothelioma: a problematic review.

    PubMed

    Moskal, T L; Urschel, J D; Anderson, T M; Antkowiak, J G; Takita, H

    1998-01-01

    Malignant pleural mesothelioma is a rare tumor that has been difficult to study. Because of disappointing treatment results, malignant pleural mesothelioma has remained an area of active research and development. A clinicopathologic review is performed in light of several problematic issues involving diagnosis, staging, natural history, and treatment. Multimodality treatment with surgery followed by adjuvant local and systemic therapy remains the most optimal therapy. Many controversial issues still exist in the treatment of malignant pleural mesothelioma. In the ensuing years newer staging systems, better preoperative staging, newer experimental therapies, and the localization of patients at expert centers will undoubtedly have an impact on disease management.

  19. Multivariate modelling with 1H NMR of pleural effusion in murine cerebral malaria

    PubMed Central

    2011-01-01

    Background Cerebral malaria is a clinical manifestation of Plasmodium falciparum infection. Although brain damage is the predominant pathophysiological complication of cerebral malaria (CM), respiratory distress, acute lung injury, hydrothorax/pleural effusion are also observed in several cases. Immunological parameters have been assessed in pleural fluid in murine models; however there are no reports of characterization of metabolites present in pleural effusion. Methods 1H NMR of the sera and the pleural effusion of cerebral malaria infected mice were analyzed using principal component analysis, orthogonal partial least square analysis, multiway principal component analysis, and multivariate curve resolution. Results It has been observed that there was 100% occurrence of pleural effusion (PE) in the mice affected with CM, as opposed to those are non-cerebral and succumbing to hyperparasitaemia (NCM/HP). An analysis of 1H NMR and SDS-PAGE profile of PE and serum samples of each of the CM mice exhibited a similar profile in terms of constituents. Multivariate analysis on these two classes of biofluids was performed and significant differences were detected in concentrations of metabolites. Glucose, creatine and glutamine contents were high in the PE and lipids being high in the sera. Multivariate curve resolution between sera and pleural effusion showed that changes in PE co-varied with that of serum in CM mice. The increase of glucose in PE is negatively correlated to the glucose in serum in CM as obtained from the result of multiway principal component analysis. Conclusions This study reports for the first time, the characterization of metabolites in pleural effusion formed during murine cerebral malaria. The study indicates that the origin of PE metabolites in murine CM may be the serum. The loss of the components like glucose, glutamine and creatine into the PE may worsen the situation of patients, in conjunction with the enhanced glycolysis, glutaminolysis and

  20. Procalcitonin use in a pediatric intensive care unit.

    PubMed

    Cies, Jeffrey J; Chopra, Arun

    2014-09-01

    We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.

  1. The established and future biomarkers of malignant pleural mesothelioma.

    PubMed

    Panou, V; Vyberg, M; Weinreich, U M; Meristoudis, C; Falkmer, U G; Røe, O D

    2015-06-01

    Malignant pleural mesothelioma (MPM) is an asbestos-related cancer with a median survival of 12months. The MPM incidence is 1-6/100,000 and is increasing as a result of historic asbestos exposure in industrialized countries and continued use of asbestos in developing countries. Lack of accurate biomarkers makes diagnosis, prognostication and treatment prediction of MPM challenging. The aim of this review is to identify the front line of MPM biomarkers with current or potential clinical impact. Literature search using the PubMed and PLoS One databases, the related-articles function of PubMed and the reference lists of associated publications until April 26th 2015 revealed a plethora of candidate biomarkers. The current gold standard of MPM diagnosis is a combination of two positive and two negative immunohistochemical markers in the epithelioid and biphasic type, but sarcomatous type do not have specific markers, making diagnosis more difficult. Mesothelin in serum and pleural fluid may serve as adjuvant diagnostic with high specificity but low sensitivity. Circulating proteomic and microRNA signatures, fibulin-3, tumor cell gene-ratio test, transcriptomic, lncRNA, glycopeptides, pleural fluid FISH assay, hyaluronate/N-ERC mesothelin and deformability cytometry may be important future markers. Putative predictive markers for pemetrexed-platinum are tumor TS and TYMS, for vinorelbine the ERCC1, beta-tubuline class III and BRCA1. Mutations of the BAP1 gene are potential markers of MPM susceptibility. In conclusion, the current status of MPM biomarkers is not satisfactory but encouraging as more sensitive and specific non-invasive markers are emerging. However, prospective validation is needed before clinical application. PMID:25979846

  2. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections

    PubMed Central

    Nobre, Vandack; Borges, Isabela

    2016-01-01

    Lower respiratory tract infections are common and potentially lethal conditions and are a major cause of inadequate antibiotic prescriptions. Characterization of disease severity and prognostic prediction in affected patients can aid disease management and can increase accuracy in determining the need for and place of hospitalization. The inclusion of biomarkers, particularly procalcitonin, in the decision taken process is a promising strategy. This study aims to present a narrative review of the potential applications and limitations of procalcitonin as a prognostic marker in hospitalized patients with lower respiratory tract infections. The studies on this topic are heterogeneous with respect to procalcitonin measurement techniques, cutoff values, clinical settings, and disease severity. The results show that procalcitonin delivers moderate performance for prognostic prediction in patients with lower respiratory tract infections; its predictive performance was not higher than that of classical methods, and knowledge of procalcitonin levels is most useful when interpreted together with other clinical and laboratory results. Overall, repeated measurement of the procalcitonin levels during the first days of treatment provides more prognostic information than a single measurement; however, information on the cost-effectiveness of this procedure in intensive care patients is lacking. The results of studies that evaluated the prognostic value of initial procalcitonin levels in patients with community-acquired pneumonia are more consistent and have greater potential for practical application; in this case, low procalcitonin levels identify those patients with a low risk of adverse outcomes. PMID:27305038

  3. Two cases of paragonimiasis westermani diagnosed after eosinophilic pleural effusion‐induced hydropneumothorax

    PubMed Central

    Ichikawa, Motoshi; Kobayashi, Daisuke; Inoue, Noriko; Shizu, Masato; Imai, Naoyuki

    2016-01-01

    Abstract Our hospital is located in the Tono region in the southeastern district of Gifu Prefecture in which there are forests and inhabitants who still hunt and eat game meat. Therefore, boar meat increases the risk of contracting paragonimiasis. We treated two patients who were infected by Paragonimus westermani after eating boar meat. They developed hydropneumothorax in association with eosinophilic pleural effusion. For patients who have pneumothorax with concomitant pleural effusion and eosinophilia in the pleural fluid analysis, it is necessary to take a detailed history, which includes flesh food consumption and travel to an endemic area, and to make a careful examination while taking into consideration parasitic infections such as paragonimiasis. PMID:27516883

  4. Thoracoscopy: medical versus surgical—in the management of pleural diseases

    PubMed Central

    2015-01-01

    Diseases of the pleura continue to affect a large population of patients worldwide and in the United States. Pleural fluid analysis and accompanying imaging of the pleura including chest X-rays, chest computed tomography (CT) scan and chest ultrasonography are among the first steps in the management of pleural effusions. When further diagnostic or therapeutic work up is necessary, open thoracotomy and thoracoscopy come to mind. However, given the significant morbidity and mortality associated with open thoracotomy, and the advances in medicine and medical instruments, thoracoscopy has now become a routine procedure in the management of the disease of the chest including pleura. Debates about surgical vs. medical thoracoscopy (MT) are ongoing. In the following pages we review the literature and discuss the similarities and differences between the two procedures, as well as their indications, contraindications, complications and efficacy in the management of pleural diseases. PMID:26807282

  5. Thoracic ultrasound for pleural effusion: delays and cost associated with departmental scanning.

    PubMed

    Bateman, K; Downey, D G; Teare, T

    2010-04-01

    Pleural effusion is a common clinical condition on medical wards and the majority of cases undergo pleural aspiration or chest drain insertion as a diagnostic or therapeutic procedure. The use of a thoracic ultrasound scan (USS) improves diagnostic yield for pleural fluid aspiration and reduces complications and USS is increasingly recommended prior to all pleural aspirations or drains and 'real time' scanning which, as well as potentially reducing delays, enhances the safety of the procedure. In many U.K hospitals a thoracic USS is still routinely performed in the radiology department. We reviewed radiology records and case notes from hospital in-patients to assess potential delays and associated costs with departmental thoracic USS and to identify cases where physician-led portable USS would potentially have improved the patient's journey. We demonstrated delays resulting in significant financial costs to the hospital of an estimated pound17, 880 per annum. However, the cost to the patient is also significant, both in terms of patient experience (many of whom will have an underlying diagnosis of metastatic carcinoma and with a limited life expectancy) but also patient safety. Respiratory physicians are increasingly recognising the importance of portable thoracic USS to guide pleural procedures and there has been increasing use of physician-led portable thoracic USS. Hospitals should be encouraged to fund both portable thoracic USS equipment but it is also crucial that training in this area is properly supported. PMID:20097552

  6. Impact of Low Procalcitonin Results on Antibiotic Administration in Hospitalized Patients at a Tertiary Care Center.

    PubMed

    Brennan, Meghan B; Osterby, Kurt; Schulz, Lucas; Lepak, Alexander J

    2016-06-01

    Procalcitonin is a sensitive and specific marker of bacterial infection; low results allow clinicians to safely de-escalate antibiotics. This retrospective cohort study aimed to determine the effect of low procalcitonin results on withholding, discontinuing, or de-escalating antibiotics in hospitalized patients at a tertiary care center. Antibiotics were initiated or continued without de-escalation in 55% of patients with low procalcitonin results. Among patients with low procalcitonin results, the primary service, but not measures of patient complexity, disease severity, or underlying disease process (lower respiratory tract infection evaluation versus systemic inflammatory response syndrome/possible sepsis) was associated with initiation or continued broad-spectrum antibiotic use. Provider-level factors may be an important variable in the initiation or continued use of broad-spectrum antibiotics for patients with low procalcitonin levels. PMID:27251126

  7. Challenges in the development of an immunochromatographic interferon-gamma test for diagnosis of pleural tuberculosis.

    PubMed

    Denkinger, Claudia M; Kalantri, Yatiraj; Schumacher, Samuel G; Michael, Joy S; Shankar, Deepa; Saxena, Arvind; Sriram, Natarajan; Balamugesh, Thangakunam; Luo, Robert; Pollock, Nira R; Pai, Madhukar; Christopher, Devasahayam J

    2013-01-01

    Existing diagnostic tests for pleural tuberculosis (TB) have inadequate accuracy and/or turnaround time. Interferon-gamma (IFNg) has been identified in many studies as a biomarker for pleural TB. Our objective was to develop a lateral flow, immunochromatographic test (ICT) based on this biomarker and to evaluate the test in a clinical cohort. Because IFNg is commonly present in non-TB pleural effusions in low amounts, a diagnostic IFNg-threshold was first defined with an enzyme-linked immunosorbent assay (ELISA) for IFNg in samples from 38 patients with a confirmed clinical diagnosis (cut-off of 300 pg/ml; 94% sensitivity and 93% specificity). The ICT was then designed; however, its achievable limit of detection (5000 pg/ml) was over 10-fold higher than that of the ELISA. After several iterations in development, the prototype ICT assay for IFNg had a sensitivity of 69% (95% confidence interval (CI): 50-83) and a specificity of 94% (95% CI: 81-99%) compared to ELISA on frozen samples. Evaluation of the prototype in a prospective clinical cohort (72 patients) on fresh pleural fluid samples, in comparison to a composite reference standard (including histopathological and microbiologic test results), showed that the prototype had 65% sensitivity (95% CI: 44-83) and 89% specificity (95% CI: 74-97). Discordant results were observed in 15% of samples if testing was repeated after one freezing and thawing step. Inter-rater variability was limited (3%; 1 out of 32). In conclusion, despite an iterative development and optimization process, the performance of the IFNg ICT remained lower than what could be expected from the published literature on IFNg as a biomarker in pleural fluid. Further improvements in the limit of detection of an ICT for IFNg, and possibly combination of IFNg with other biomarkers such as adenosine deaminase, are necessary for such a test to be of value in the evaluation of pleural tuberculosis. PMID:24376880

  8. Pancreatic-pleural fistula in chronic pancreatitis.

    PubMed

    Elkaoui, Hakim; Atoini, Fouad; Bouchentouf, Sidi Mohamed; El Omari, Fatima; Mahi, Mohamed; Ait Ali, Abdelmounaim; Bounaim, Ahmed; Sair, Khalid; Zentar, Aziz

    2012-03-01

    Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage. PMID:22560825

  9. An IR Navigation System for Pleural PDT

    PubMed Central

    Zhu, Timothy C.; Liang, Xing; Kim, Michele M.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles B.; Friedberg, Joseph S.; Cengel, Keith A.

    2015-01-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for malignant pleural mesothelioma (MPM). In the current pleural PDT protocol, a moving fiber-based point source is used to deliver the light. The light fluences at multiple locations are monitored by several isotropic detectors placed in the pleural cavity. To improve the delivery of light fluence uniformity, an infrared (IR) navigation system is used to track the motion of the light source in real-time at a rate of 20 – 60 Hz. A treatment planning system uses the laser source positions obtained from the IR camera to calculate light fluence distribution to monitor the light fluence uniformity on the surface of the pleural cavity. A novel reconstruction algorithm is used to determine the pleural cavity surface contour. A dual-correction method is used to match the calculated fluences at detector locations to the detector readings. Preliminary data from a phantom shows superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown with and without the correction method. PMID:25995987

  10. Thoracoscopic management of pleural effusions revisited.

    PubMed

    Yim, A P; Ho, J K; Lee, T W; Chung, S S

    1995-05-01

    Pleural effusion is a commonly encountered clinical condition. We report our experience with video assisted thoracoscopic surgery (VATS) in the management of pleural effusions in three groups of patients: (1) Patients with cryptogenic pleural effusions for diagnosis; (2) patients with established malignant effusions for talc insufflation and limited decortication; and (3) patients with early empyema for debridement and drainage. From September 1992 to March 1994, we have successfully managed 28 patients with pleural effusions (12 males, 16 females; age ranged from 22 days to 73 years). Management consisted of 16 diagnostic thoracoscopies with guided pleural biopsies, seven limited decortications for trapped lungs, 12 talc insufflation for recurrent symptomatic malignant effusions and debridement and drainage of five empyemata. There was no mortality or intra-operative complications. The procedure was tolerated well by all patients. The mean duration of chest drainage and hospital stay were 1.2 and 2.8 days for group 1 patients, 4.5 and 6.4 days for group 2, and 5.6 and 7.1 days for group 3. Specific histological diagnosis was obtained in all but two patients (88%). Thoracoscopic talc insufflation was successful in 92% of cases at mean follow up of 8 months. Thoracoscopic debridement and drainage of empyema resulted in rapid resolution of sepsis in all cases. Advances in video camera technology and instrumentation have allowed more therapeutic manoeuvres to be carried out. We conclude that VATS is a safe and effective way of managing selected patients with pleural effusions.

  11. Pleural procedural complications: prevention and management

    PubMed Central

    Psallidas, Ioannis; Wrightson, John M.; Hallifax, Robert J.; Rahman, Najib M.

    2015-01-01

    Pleural disease is common with a rising case frequency. Many of these patients will be symptomatic and require diagnostic and/or therapeutic procedures. Patients with pleural disease present to a number of different medical specialties, and an equally broad range of clinicians are therefore required to have practical knowledge of these procedures. There is often underestimation of the morbidity and mortality associated with pleural interventions, even those regarded as being relatively straightforward, with potentially significant implications for processes relating to patient safety and informed consent. The advent of thoracic ultrasound (TUS) has had a major influence on patient safety and the number of physicians with the necessary skill set to perform pleural procedures. As the variety and complexity of pleural interventions increases, there is increasing recognition that early specialist input can reduce the risk of complications and number of procedures a patient requires. This review looks at the means by which complications of pleural procedures arise, along with how they can be managed or ideally prevented. PMID:26150919

  12. A Large Pleural Effusion following Abdominal Aortic Surgery

    PubMed Central

    Ramsaran, Vinoo K.; Seeram, Vandana K.; Cury, James; Shujaat, Adil

    2015-01-01

    Chylous ascites and coexistent chylothorax is a rare but important complication following retroperitoneal abdominal surgery. We report a 70-year-old male who developed gradual abdominal distension, chest tightness, and dyspnea five months after having an uncomplicated aortobifemoral bypass performed. Physical examination was consistent with a large right sided effusion and ascites which were confirmed by computed tomography. Thoracentesis yielded an opaque milky fluid with analysis consistent with a chylothorax with a paracentesis revealing fluid that was similar in both appearance and biochemistry. The patient failed initial conservative management so a chest tube was placed followed by chemical pleurodesis. We review the literature of the pathophysiology and treatment approach to such a pleural effusion. PMID:26635989

  13. Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

    PubMed Central

    2014-01-01

    Background Many studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using pleural cholesterol or the ratio of cholesterol in pleural fluid to cholesterol in serum (P/S cholesterol ratio) as diagnostic tests to help identify pleural exudates. Methods Literature databases were systematically searched for studies examining accuracy of pleural cholesterol or P/S cholesterol ratios for diagnosing pleural exudates. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using bivariate-effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance. Results Our meta-analysis included up to 20 studies involving 3,496 subjects. Summary estimates for pleural cholesterol in the diagnosis of pleural exudates were as follows: sensitivity, 0.88 (95%CI 0.84 to 0.92); specificity, 0.96 (95% CI 0.92 to 0.98); PLR, 20.31 (95% CI 11.21 to 36.78); NLR, 0.12 (95% CI 0.09 to 0.17); DOR, 167.06 (95% CI 76.79 to 363.95); and AUC 0.97 (95% CI 0.95 to 0.98). The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94 (95% CI 0.92 to 0.96); specificity, 0.87 (95% CI 0.83 to 0.91); PLR 7.46 (95% CI, 5.47 to 10.19); NLR, 0.07 (95% CI 0.05 to 0.10); DOR, 107.74 (95% CI 60.91 to 190.60); and AUC 0.97 (95% CI 0.95 to 0.98). Conclusions Both pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates. Nevertheless, the results of pleural cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information. PMID:24731290

  14. Pleural effusion secondary to metastasis of an ovarian adenocarcinoma in a horse.

    PubMed

    Morris, D D; Acland, H M; Hodge, T G

    1985-08-01

    An 11-year-old Quarter Horse mare was presented with ventral edema and pleural effusion, secondary to a disseminated ovarian adenocarcinoma. Bilateral thoracocentesis yielded 30 L of thin, blood-tinged fluid, which was a modified transudate. Cytologic examination of the fluid revealed large atypical cells, suggestive of carcinomatous neoplasia. Similar cells were found in the peritoneal fluid. The mare was euthanatized. Necropsy revealed a 35-cm diameter mass in the cranial mediastinum, ventral to the trachea. The left ovary was 25 cm in diameter and most of the parenchyma was replaced by red or brown friable tissue, containing numerous 1-to 3-mm cysts. Papillary adenocarcinoma of the ovary was diagnosed, based on the appearance and arrangement of tumor cells in the ovary, sublumbar and tracheobronchial lymph nodes, and mediastinal mass. Ovarian neoplasia should be considered in the differential diagnosis of pleural effusion in the horse. PMID:4030465

  15. [Evaluation of coefficient of variation of age in pleural effusion in António Pedro Hospital, Niterói city, state of Rio de Janeiro, Brazil].

    PubMed

    da Silva Junior, Cyro Teixeira; Behrsin, Rodolfo Fred; Cardoso, Gilberto Perez; Monteiro, Nicolau Pedro

    2003-01-01

    Pleural effusion is a frequent syndrome in Brazil. Tuberculosis is the most prevalent (P) cause. The coefficient of variation (CV) is a useful single measure of variability. The objective of the present work was to evaluate the coefficient of variation in pleural effusion, having as variable the age. 215 patients had appeared after diagnostic physician and for image of syndrome of pleural effusions. Diagnostic thoracentesis, tests on pleural fluid and others invasive surgical procedures to the approach to a patient with pleural effusion. Tuberculosis (P=56.0%; CV=39,7%), adenocarcinoma (P=11.0%; CV=25.1%), transudates (P=12.0%; CV=19.6%), lymphomas (P=2.0%; CV=34.6%), systemic lupus erythematosus (P=2.0%; CV=38.7%), empyema pleural not tuberculosis (P=5.0%; CV=42.2%), pulmonary infarction (P=4.0 %; CV=30.1%) and parapneumonic (P=4.0 %; CV=38.9%) are the causes more prevalent. The analysis on the date showed that the coefficient of variation of age in pleural effusions was high and very high. The values of the coefficient of variation translate a high degree of dispersion of the age of the patients in each cause of pleural effusion.

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

    PubMed

    Bianchi, C; Brollo, A; Ramani, L; Zuch, C

    1997-11-01

    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.

  17. Pleural effusion as the initial extramedullary manifestation of Acute Myeloid Leukemia

    PubMed Central

    Nieves-Nieves, José

    2012-01-01

    Leukemias rarely debut by pleural involvement as the first manifestation of the hematologic malignancy. This complication is most commonly seen in solid tumors such as carcinomas of the breast, lung, gastrointestinal tract and lymphomas. We present a case of a 66 year old male who presented with a pleural leukemic infiltration of his undiagnosed Acute Myeloid Leukemia that was not a complication of the disease extension, but the acute presentation of the illness. Progressive shortness of breath for two weeks, cough, clear sputum and weight loss were the initial complaints. Serum dyscrasia suggested a hematologic abnormality. A chest x-ray performed demonstrated a buildup of fluid with layering in the left pleural cavity. Diagnostic thoracentesis suggested an exudative etiology with cytology remarkable for 62% leukemic myeloblast. The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect. Chemotherapy was initiated, though no remission achieved with induction chemotherapy. Complications and disease progression precludes in the patient’s death. Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid. PMID:24358836

  18. Chemical pleurodesis in malignant pleural effusions: a randomised prospective study of mepacrine versus bleomycin.

    PubMed Central

    Koldsland, S.; Svennevig, J. L.; Lehne, G.; Johnson, E.

    1993-01-01

    BACKGROUND--The treatment of recurrent pleural effusion in advanced malignant disease should be efficient and with tolerable side effects. Since 1983 intrathoracic instillation of the anti-malaria drug mepacrine has been used to achieve pleurodesis. The cytotoxic drug bleomycin has been claimed to be equally effective and with fewer side effects. The present study was designed to compare these two agents. METHODS--Forty patients with carcinoma and pleural effusions refractory to repeated pleural aspirations over the previous 12 weeks were randomised to receive treatment with intrathoracic instillation of mepacrine or bleomycin. Fluid volumes before and after pleurodesis, drainage time, and side effects were registered and analysed, and the response to treatment was evaluated by clinical examination and chest radiography. RESULTS--The amount of fluid produced after treatment in the patients receiving mepacrine was lower than in those receiving bleomycin, and the duration of chest drainage was shorter. After 30 days 16 of 20 in the mepacrine group responded to treatment and 10 of 20 in the bleomycin group. Most patients died during the three months observation period. Moderate side effects occurred equally in both groups. CONCLUSIONS--Chemical pleurodesis can reduce or stop pleural effusion in many patients, and in this study mepacrine appeared to be more efficient than bleomycin. A prospective study with a larger number of patients is now warranted. PMID:7692617

  19. Pleural Tuberculosis Mimicking Inflammatory Pseudotumour

    PubMed Central

    P., Arul; Varghese, Renu G’boy; Ramdas, Anita

    2013-01-01

    A pseudotumour is a rare presentation of bronchopulmonary tuberculosis which occurs in immunocompetent patients, which can simulate malignancy, both clinically and radiologically, and may cause delay in its diagnosis and treatment. The incidence of bronchopulmonary pseudotumours was found to vary from 2-4%, as was seen in various studies. A mycobacterial pseudotumour of the pleura is a rare entity. We are reporting a case of a pleura based tubercular pseudotumour in a 59 years old patient who presented with a four month history of the nonspecific symptoms of cough and chest pain. The radiological investigations showed that a pleural based mass lesion was occupying the right lower hemithorax. The initial biopsy was suggestive of a hyalinizing variant of an inflammatory pseudotumour. The follow-up surgical resected mass was consistent with the features of a tubercular granuloma. The clinical presentation and the histopathological findings have been presented, with a brief review of the literature. Due to its varied and unusual presentation, bronchopulmonary tuberculosis should always be kept in mind when a patient with a similar clinical and a radiological picture is being evaluated. PMID:23730653

  20. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

    PubMed Central

    Kim, Yoon Kyung; Lee, Kyung Won; Yi, Chin A; Koo, Jin Mo; Jung, Soon-Hee

    2016-01-01

    Objective To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). Materials and Methods The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Results Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Conclusion Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD. PMID:27390546

  1. Talc pleurodesis as surgical palliation of patients with malignant pleural effusion. Analysis of factors affecting survival.

    PubMed

    Lumachi, Franco; Mazza, Francesco; Ermani, Mario; Chiara, Giordano B; Basso, Stefano M M

    2012-11-01

    Malignant pleural effusion (MPE) is common in most patients with advanced cancer, especially in those with lung cancer, metastatic breast carcinoma and lymphoma. This complication usually leads patients to suffer from significant dyspnea, which may impair their mobility and reduce their quality of life. In patients with MPE, several interventions have been shown to be useful for palliation of the symptoms, including talc pleurodesis. The aim of this study was to evaluate prognostic factors for survival of patients with symptomatic MPE who underwent palliative video-assisted thoracoscopic (VATS) talc pleurodesis. Thirty-five patients with MPE underwent VATS, evacuation of the pleural fluid and talc pleurodesis with large-particle talc. There were 22 (62.9%) males and 13 (37.1%) females, with an overall median age of 69 years (range 42-81 years). The main causes of MPE were non-small cell lung carcinoma, breast or ovarian cancer and malignant pleural mesothelioma. The age did not differ (p=0.88) between men (68.6±11.6 years) and women (68.0±8.7 years). The mean quantity of pleural effusion was 2005.7±1078.9 ml, while the overall survival was 11.2±8.9 months. We did not find any relationship between survival and gender (log-rank test, p=0.53) or underlying malignancy associated with MPE (p=0.89, 0.48 and 0.36 for secondary cancer, lung cancer and mesothelioma, respectively). Similarly, no correlation was found between survival and age of the patients (Cox's regression, p=0.44) or quantity of pleural effusion (p=0.88). Our results show that the prognosis of patients after talc pleurodesis is independent of age, gender, type of malignancy and amount of pleural effusion, thus, suggesting the utility of treating all patients with symptomatic MPE early.

  2. Malignant pleural mesothelioma: a clinicopathological study.

    PubMed

    Qua, J C; Rao, U N; Takita, H

    1993-09-01

    In this paper the results of a retrospective review of 58 patients with malignant pleural mesothelioma treated at our Institute are reported. There were 50 males and 8 females; the mean age was 56.3 years (range: 13-77). History of asbestos exposure was ascertained in 25 patients (43%). The most common finding in chest X-ray was pleural effusion which was seen in 47/58 patients on presentation. The cytological examination of pleural effusion was most of the time nondiagnostic. Pleural biopsy was needed for the correct diagnosis. Pathologically, 26 patients (44.8%) had epithelial type, 24 patients (41.4%) had mixed type, and 8 patients (13.8%) had fibrous or sarcomatous type of pleural mesothelioma. Most of the patients on presentation had Stage I disease by Butchart's classification. The overall survival time ranged from 1 month to as long as 17 years with a median of 12.5 months. The mean survival of patients who received nonsurgical therapies was 7-13.4 months. Thirteen patients were treated surgically: three patients survived over 5 years, but the median survival was 15 months. Six patients received no treatment, and the median survival was seven months.

  3. Pleural lipoma: a non-surgical lesion?

    PubMed Central

    Jayle, Christophe; Hajj-Chahine, Jamil; Allain, Geraldine; Milin, Serge; Soubiron, Laurent; Corbi, Pierre

    2012-01-01

    Pleural lipomas are benign tumours that develop at the expense of adipose tissues, and they never evolve towards liposarcoma. Located usually at the mediastinal, bronchial and pulmonary levels, a pleural situation is extremely rare. Chest X-rays usually detect them and computed tomography scans confirm the diagnosis. As complications occur, a wait-and-see policy is common. We report our pleural lipoma surgical exeresis experience since 1999. We have operated on five cases of pleural lipomas among nearly 1800 cases of thoracic exeresis: three male and two female patients, without obesity (in all cases, body mass index (BMI) < 28). The mean age was 54.6 years (range 35–72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas. PMID:22371386

  4. Pleural Empyema and Aortic Aneurysm

    PubMed Central

    Wu, Ching-Yang; Su, Ta-Wei; Huang, Kuo-Yang; Ko, Po-Jen; Yu, Sheng-Yueh; Kao, Tsung-Chi; Shen, Te-Chun; Chou, Tzu-Yi; Lin, Cheng-Li; Kao, Chia-Hung

    2015-01-01

    Abstract Pleural empyema (PE) may evolve into necrosis, fistula in the thorax, and sepsis; thus, it is also associated with high mortality. We investigated and analyzed the risk of aortic aneurysm (AA) in a cohort study of patients with PE. A total of 34,250 patients diagnosed with PE were identified as the PE cohort, and 137,000 patients without PE were selected randomly as the control group and matched by sex, age, and index year of PE diagnosis. Patients ages 20 years and younger with a history of AA were excluded. The risk of AA was analyzed using a Cox proportional hazards regression model. Excess risk of AA development was 1.69-fold higher in PE patients (adjusted hazard ratio [aHR] = 1.69; 95% confidence interval [CI] = 1.39–2.05) compared with non-PE patients. The patients with PE exhibited a greater adjusted risk of AA (aHR = 2.01; CI = 1.44–2.81) even if they did not have any of the 9 comorbidities included in our analysis (diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, heart failure, cardiac artery disease, stroke, bacterial endocarditis, and rheumatic endocarditis). Compared with the patients without any of the 9 comorbidities or PE, the patients with only PE had a greater risk of developing AA (aHR = 2.00; CI = 1.43–2.79). The PE cohort had a significantly higher cumulative incidence of AA than the non-PE cohort did during 12 years of follow-up. In a large-scale cohort, patients with PE are linked with an increased risk of AA. PMID:26632741

  5. [The radiologic description of pleural effusions with special reference to an additional projection].

    PubMed

    Hartung, K

    1989-01-01

    Pleural effusions refer to many different conditions of the pleura itself or to generalized diseases. Small amounts of fluid may not be apparent on conventional radiographs. Regarding the standard views the ventrodorsal projection shows the earliest signs of effusion, followed by the lateral recumbent. But even in these projections it is not possible to see a small amount of fluid. An additional lateral oblique view which you obtain by lifting the extremities seems to show small amounts of fluid more precisely and earlier than any of the standard projections. PMID:2669229

  6. Prolonged pleural catheters in the management of pleural effusions due to breast cancer

    PubMed Central

    Ordu, Cetin; Toker, Alper

    2014-01-01

    Background Breast cancer is the second most common etiologic cause in malignant pleural effusions (MPE). The aim of this study was to investigate the efficacy of long term pleural catheters in inducing self sclerosis in pleural effusions of breast cancer patients. Methods In this study, 26 patients with breast cancer relapleural effusions that occurred between January 2011 and July 2013, who were considered not to undergo any other treatments and managed with prolonged pleural catheters (Jackson-Pratt silicone flat drain), were retrospectively analyzed. Thirty pleural catheters were inserted in 26 patients. All patients were female, mean age was 52 (range, 37-66) years old. Drainage over 1,500 mL per day was not allowed in order to avoid a lung edema. The catheters were removed in patients who had restoration of lung expansion and drainage under 50 mL/day. Results The histologic subtypes in pleural effusions were invasive ductal carcinoma in 18 patients, ductal carcinoma in situ in 4, invasive lobular carcinoma in 2, tubular carcinoma in 1, and medullary carcinoma in 1. Three of the 26 patients underwent bilateral catheter insertion, and one patient underwent a reinsertion of the catheter into the same hemithorax due to a recurrence. The catheters were retained for a mean period of 18 days (range, 11-38 days). In one patient with invasive ductal carcinoma and paramalignant pleural effusion (PMPE) (3.8%), a recurrent pleural effusion was seen 34 days after removal of the catheter. There were no complications. One patient died while the catheter was in place. Conclusions Prolonged catheters for the management of pleural effusions in selected patients have become more popular than other treatment alternatives due to a shorter length of stay and lower costs. We recommend the use of Jackson Pratt (JP) silicone flat drains which in our opinion provide effective pleurodesis in addition to easy application in recurrent effusions caused by breast cancer. PMID:24605219

  7. Clinico- pathological profile and course of malignant pleural effusion in a tertiary care teaching hospital in western U.P. with special reference to lung cancer

    PubMed Central

    Agrawal, Anurag; Tandon, Rajeev; Singh, Lalit; Chawla, Aakanksha

    2015-01-01

    Background: Malignant pleural effusion is a major clinical problem associated with primary and metastatic pleural malignancies. Pleural effusions from an unknown primary are responsible for 7-15% of all malignant pleural effusions. Presence of malignant pleural effusion puts the patient in advanced stage and renders the prognosis as poor. Aim: In this study we intend to find out the incidence of malignant pleural effusion, its aetiology and clinical course in patients attending a tertiary care teaching hospital. Results: A total of 308 patients were included in this study. A majority of the patients were in age group 50- 70 years (median age = 58.8 years; range 32- 85 yrs). Male to female ratio was 2.5:1. The major primary cancers were lung cancer (135), lymphoma (40), breast cancer (36), female genital tract (30) gastrointestinal (21), and others (8). In 38 cases primary remained unknown. The yields of pleural fluid cytology, blind pleural biopsy, CT/USG guided pleural biopsy and thoracoscopy were 60%, 49%, 76% and 91% respectively. Chemical pleurodesis yielded complete response in 80%, incomplete response in another 13% patients. Only 136 (44%) cases could be followed up for minimum of 6 months. A majority of them (95, 69.85%) died. Conclusion: We conclude that malignant pleural effusion is a commonly misdiagnosed medical entity. Lung cancer is the commonest cause. Despite all efforts, in about 15% of the cases, primary remains undiagnosed. Thoracoscopy/pleuroscopy is a cost effective measure for diagnosis. Chemical pleurodesis provides expected results but mortality remains high. PMID:26180380

  8. The pathology of parietal pleural plaques

    PubMed Central

    Roberts, G. Hefin

    1971-01-01

    The incidence, morbid anatomy, histology, and relationship of hyaline pleural plaques to exposure to asbestos has been studied. Plaques were found in 12·3% of 334 hospital necropsies (in an urban population in Glasgow, 41 cases). In 85·3% (35 cases) asbestos bodies were found in the lungs. There is evidence of a dose-response relationship between the number of asbestos bodies found in the lungs and the presence of pleural plaques. The selective distribution of plaques within the pleural cavities suggests that mechanical factors play a part in their localization. Histological examination contributed little to understanding the mechanism of plaque formation; that asbestos bodies have been detected in only a few cases suggest that their presence in the parietal pleura is not essential to plaque formation. The suggested mechanisms of plaque formation are discussed. Images PMID:5556121

  9. A Pleural Loose Body Mimicking a Pleural Tumor: A Case Report

    PubMed Central

    Shim, Sung Shine; Chun, Eun Mi; Won, Tae Hee; Park, Sanghui

    2015-01-01

    We present a rare case of a pleural loose body, thought to be a pedunculated pleural tumor, found incidentally in a 58-year-old female. Computed tomography showed a non-enhancing mass, which migrated along the mediastinum and paravertebral area. Thoracoscopic surgery revealed a 4 cm, soap-like mass that was found to be a fibrin body consisting of hyalinized collagen histopathologically. Mobility and the lack of contrast enhancement of a pleural mass are important clues to diagnosing this benign condition. PMID:26355378

  10. Chest wall, lung, and pleural space trauma.

    PubMed

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  11. Pleural Empyema due to Group D Salmonella

    PubMed Central

    Kam, Jennifer C.; Abdul-Jawad, Sami; Modi, Chintan; Abdeen, Yazan; Asslo, Fady; Doraiswamy, Vikram; DePasquale, Joseph R.; Spira, Robert S.; Baddoura, Walid; Miller, Richard A.

    2012-01-01

    Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease. We present a case of a 66-year-old female with underlying pulmonary pathology, secondary to an extensive smoking history, who presented with a left-sided pleural effusion. The causative agent was identified as being group D Salmonella. Decortication of the lung was performed and the patient was discharged on antibiotics with resolution of her symptoms. This case helps to support the inclusion of Salmonella group D as a possible etiological agent of infection in the differential causes of exudative pleural effusions. PMID:23056966

  12. Toxocariasis: An unusual cause of pleural effusion.

    PubMed

    Vallentin, Blandine; Carsin, Ania; Dubus, Jean-Christophe

    2015-10-01

    Toxocara canis, one of the most frequent parasites worldwide, rarely triggers respiratory symptoms. We report the case of a 5-year-old girl hospitalized for a unilateral eosinophilic pleural effusion due to Toxocara canis. Besides the fact that she was living in a squat, no other medical condition was reported. There was no other site of infection caused by the parasite and she was successfully treated with albendazole. This case report is obviously unique as very few cases of pleural effusion due to Toxocara canis are reported in literature, all in adult patients. PMID:25847394

  13. Treatment of malignant pleural effusion: a method using tube thoracostomy and talc.

    PubMed

    Adler, R H; Sayek, I

    1976-07-01

    Our experience with a simple bedside method for controlling recurrent symptomatic malignant pleural effusion is presented. The method consists of intercostal tube thoracostomy, instillation of a suspension of talc, and waterseal suction drainage. Based on our experience, we believe certain criteria should be met before undertaking talc pleurodesis. In properly selected patients the results with tube thoracostomy and talc pleurodesis have been uniformly good in preventing fluid recurrence and return of disabling symptoms. The technique and results are discussed.

  14. Parenchymal stress affects interstitial and pleural pressures in in situ lung.

    PubMed

    Miserocchi, G; Negrini, D; Gonano, C

    1991-11-01

    After resecting the intercostal muscles and thinning the endothoracic fascia, we micropunctured the lung tissue through the intact pleural space at functional residual capacity (FRC) and at volumes above FRC to evaluate the effect of increasing parenchymal stresses on pulmonary interstitial pressure (Pip). Pip was measured at a depth of approximately 230 microns from the pleural surface, at 50% lung height, in 12 anesthetized paralyzed rabbits oxygenated via a tracheal tube with 50% humidified O2. Pip was -10 +/- 1.5 cmH2O at FRC. At alveolar pressure of 5 and 10 cmH2O, lung volume increased by 8.5 and 19 ml and Pip decreased to -12.4 +/- 1.6 and -12.3 +/- 5 cmH2O, respectively. For the same lung volumes held by decreasing pleural surface pressure to about -5 and -8.5 cmH2O, Pip decreased to -17.4 +/- 1.6 and -23.8 +/- 5 cmH2O, respectively. Because Pip is more negative than pleural pressure, the data suggest that in intact pulmonary interstitium the pressure of the liquid phase is primarily set by the mechanisms controlling interstitial fluid turnover.

  15. Friction and lubrication of pleural tissues.

    PubMed

    D'Angelo, Edgardo; Loring, Stephen H; Gioia, Magda E; Pecchiari, Matteo; Moscheni, Claudia

    2004-08-20

    The frictional behaviour of rabbit's visceral pleura sliding against parietal pleura was assessed in vitro while oscillating at physiological velocities and amplitudes under physiological normal forces. For sliding velocities up to 3 cm s(-1) and normal compressive loads up to 12 cm H2O, the average value of the coefficient of kinetic friction (mu) was constant at 0.019 +/- 0.002 (S.E.) with pleural liquid as lubricant. With Ringer-bicarbonate solution, mu was still constant, but significantly increased (Deltamu = 0.008 +/- 0.001; P < 0.001). Under these conditions, no damage of the sliding pleural surfaces was found on light and electron microscopy. Additional measurements, performed also on peritoneum, showed that changes in nominal contact area or strain of the mesothelia, temperature in the range 19-39 degrees C, and prolonged sliding did not affect mu. Gentle application of filter paper increased mu approximately 10-fold and irreversibly, suggesting alteration of the mesothelia. With packed the red blood cells (RBC) between the sliding mesothelia, mu increased appreciably but reversibly on removal of RBC suspension, whilst no ruptures of RBC occurred. In conclusion, the results indicate a low value of sliding friction in pleural tissues, partly related to the characteristics of the pleural liquid, and show that friction is independent of velocity, normal load, and nominal contact area, consistent with boundary lubrication.

  16. Diaphragmatic hernia simulating a left pleural effusion.

    PubMed

    Wooldridge, Jamie L; Partrick, David A; Bensard, Denis D; Deterding, Robin R

    2003-12-01

    We review a case of a diaphragmatic hernia simulating on chest radiograph left lower lobe pneumonia and associated pleural effusion. We also characterize the atypical chest radiographic findings of this patient and recommend further imaging with computed tomography in unusual patient presentations.

  17. Automatic spatiotemporal matching of detected pleural thickenings

    NASA Astrophysics Data System (ADS)

    Chaisaowong, Kraisorn; Keller, Simon Kai; Kraus, Thomas

    2014-01-01

    Pleural thickenings can be found in asbestos exposed patient's lung. Non-invasive diagnosis including CT imaging can detect aggressive malignant pleural mesothelioma in its early stage. In order to create a quantitative documentation of automatic detected pleural thickenings over time, the differences in volume and thickness of the detected thickenings have to be calculated. Physicians usually estimate the change of each thickening via visual comparison which provides neither quantitative nor qualitative measures. In this work, automatic spatiotemporal matching techniques of the detected pleural thickenings at two points of time based on the semi-automatic registration have been developed, implemented, and tested so that the same thickening can be compared fully automatically. As result, the application of the mapping technique using the principal components analysis turns out to be advantageous than the feature-based mapping using centroid and mean Hounsfield Units of each thickening, since the resulting sensitivity was improved to 98.46% from 42.19%, while the accuracy of feature-based mapping is only slightly higher (84.38% to 76.19%).

  18. Detection, modeling and matching of pleural thickenings from CT data towards an early diagnosis of malignant pleural mesothelioma

    NASA Astrophysics Data System (ADS)

    Chaisaowong, Kraisorn; Kraus, Thomas

    2014-03-01

    Pleural thickenings can be caused by asbestos exposure and may evolve into malignant pleural mesothelioma. While an early diagnosis plays the key role to an early treatment, and therefore helping to reduce morbidity, the growth rate of a pleural thickening can be in turn essential evidence to an early diagnosis of the pleural mesothelioma. The detection of pleural thickenings is today done by a visual inspection of CT data, which is time-consuming and underlies the physician's subjective judgment. Computer-assisted diagnosis systems to automatically assess pleural mesothelioma have been reported worldwide. But in this paper, an image analysis pipeline to automatically detect pleural thickenings and measure their volume is described. We first delineate automatically the pleural contour in the CT images. An adaptive surface-base smoothing technique is then applied to the pleural contours to identify all potential thickenings. A following tissue-specific topology-oriented detection based on a probabilistic Hounsfield Unit model of pleural plaques specify then the genuine pleural thickenings among them. The assessment of the detected pleural thickenings is based on the volumetry of the 3D model, created by mesh construction algorithm followed by Laplace-Beltrami eigenfunction expansion surface smoothing technique. Finally, the spatiotemporal matching of pleural thickenings from consecutive CT data is carried out based on the semi-automatic lung registration towards the assessment of its growth rate. With these methods, a new computer-assisted diagnosis system is presented in order to assure a precise and reproducible assessment of pleural thickenings towards the diagnosis of the pleural mesothelioma in its early stage.

  19. Clinical profile of pleural empyema and associated factors with prolonged hospitalization in paediatric tertiary centre in Angola, Luanda.

    PubMed

    de Britto, Murilo Carlos Amorim; da Conceicao Silvestre, Silvia Maria Mendes; do Carmo Menezes Duarte, Maria; de Matos Bezerra, Patricia Gomes

    2008-04-01

    In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.

  20. Systematic use of universal 16S rRNA gene polymerase chain reaction (PCR) and sequencing for processing pleural effusions improves conventional culture techniques.

    PubMed

    Insa, Rosario; Marín, Mercedes; Martín, Adoración; Martín-Rabadán, Pablo; Alcalá, Luís; Cercenado, Emilia; Calatayud, Laura; Liñares, Josefina; Bouza, Emilio

    2012-03-01

    Conventional culture of pleural fluid samples frequently provides false-negative results. Universal polymerase chain reaction (PCR) of the 16S ribosomal ribonucleic acid (rRNA) gene (16S PCR) has proven useful in the diagnosis of various bacterial infections. We conducted a prospective study to assess the value of 16S PCR in the etiologic diagnosis of pleural effusion. All pleural fluid samples received for culture were also studied using 16S PCR. Positive samples were sequenced for identification. Clinical records and conventional culture results were analyzed to classify pleural fluid samples as infected or not infected. We studied 723 samples. We excluded 188 samples because they were obtained from a long-term chest tube, there was a diagnosis of mycobacterial infection, or there were insufficient data to classify the episode. Finally, 535 pleural fluid samples were analyzed. According to our criteria, 82 (15.3%) were infected and 453 (84.7%) were not infected. In the infected samples, 16S PCR was positive in 67 samples (81.7%) while conventional culture was positive in 45 (54.9%). There were 4 false positives with 16S PCR (0.9%) and 12 with culture (2.6%). The values for the etiologic diagnosis of bacterial pleural effusion of conventional culture compared with 16S PCR were as follows: sensitivity, 54.9%/81.7%; specificity, 97.4%/99.1%; positive predictive value, 76.3%/94.4%; negative predictive value, 92.6%/96.8%; and accuracy, 90.8%/96.5%.When compared with conventional culture, 16S PCR plus sequencing substantially improves the etiologic diagnosis of infectious pleural effusion. In our opinion, this technique should be added to the routine diagnostic armamentarium of clinical microbiology laboratories.

  1. The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies

    PubMed Central

    Lee, Hans J.; Skalski, Joseph H.; Maldonado, Fabien; Wahidi, Momen; Choi, Philip J.; Bessich, Jamie; Sterman, Daniel; Argento, A. Christine; Shojaee, Samira; Gorden, Jed A.; Wilshire, Candice L.; Feller-Kopman, David; Ortiz, Ricardo; Nonyane, Bareng Aletta Sanny; Yarmus, Lonny

    2015-01-01

    BACKGROUND: Malignant pleural effusion is a common complication of advanced malignancies. Indwelling tunneled pleural catheter (IPC) placement provides effective palliation but can be associated with complications, including infection. In particular, hematologic malignancy and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review outcomes in patients with hematologic malignancy undergoing IPC placement. METHODS: A retrospective multicenter study of IPCs placed in patients with hematologic malignancy from January 2009 to December 2013 was performed. Inclusion criteria were recurrent, symptomatic pleural effusion and an underlying diagnosis of hematologic malignancy. Records were reviewed for patient demographics, operative reports, and pathology, cytology, and microbiology reports. RESULTS: Ninety-one patients (mean ± SD age, 65.4 ± 15.4 years) were identified from eight institutions. The mean × SD in situ dwell time of all catheters was 89.9 ± 127.1 days (total, 8,160 catheter-days). Seven infectious complications were identified, all of the pleural space. All patients were admitted to the hospital for treatment, with four requiring additional pleural procedures. Two patients died of septic shock related to pleural infection. CONCLUSIONS: We present, to our knowledge, the largest study examining clinical outcomes related to IPC placement in patients with hematologic malignancy. An overall 7.7% infection risk and 2.2% mortality were identified, similar to previously reported studies, despite the significant immunosuppression and pancytopenia often present in this population. IPC placement appears to remain a reasonable clinical option for patients with recurrent pleural effusions related to hematologic malignancy. PMID:25789576

  2. Procalcitonin beyond the acute phase: novel biomediator properties?

    PubMed

    Panico, Carolina; Nylen, Eric

    2013-01-01

    Since inflammation has been linked to carcinogenic events, discovery of relevant biomarkers may have important preventative implications. Procalcitonin (ProCT) has been shown to be an important prognostic biomarker in severe inflammatory conditions, but there is no data regarding its biomarker role, if any, beyond the acute phase. In a recent study published in BMC Medicine, Cotoi et al. analyzed whether serum ProCT levels in healthy individuals are associated with mortality outcomes. The results are affirmative in that baseline ProCT was shown to be strongly and independently associated with all-cause and cancer mortality and with the incidence of colon cancer in men. By contrast, the study indicated that high sensitivity C-reactive protein was independently associated with cardiovascular mortality but not with cancer mortality in men. Thus, baseline levels of ProCT appear to have prognostic biomarker implications potentially related to its emerging biomediator action(s). PMID:23984981

  3. Municipal pleural cancer mortality in Spain

    PubMed Central

    Lopez-Abente, G; Hernandez-Barrera, V; Pollan, M; Aragones, N; Perez-Gomez, B

    2005-01-01

    Background: Pleural cancer is a recognised indicator of exposure to asbestos and mesothelioma mortality. Aims: To investigate the distribution of municipal mortality due to this tumour, using the autoregressive spatial model proposed by Besag, York, and Molliè. Methods: It was possible to compile and ascertain the posterior distribution of relative risk on the basis of a single Bayesian spatial model covering all of Spain's 8077 municipal areas. Maps were plotted depicting standardised mortality ratios, smoothed relative risk (RR) estimates, and the distribution of the posterior probability that RR >1. Results: There was a higher risk of death due to pleural cancer in well defined towns and areas, many of which correspond to municipalities where asbestos using industries once existed for many years, the prime example being the municipal pattern registered for Barcelona Province. The quality of mortality data, the suitability of the model used, and the usefulness of municipal atlases for environmental surveillance are discussed. PMID:15723885

  4. A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion

    PubMed Central

    Mishra, Ashwini Kumar; Verma, Sanjeev Kumar; Kant, Surya; Kushwaha, Ram Awadh; Garg, Rajiv; Kumar, Santosh; Prakash, Ved; Verma, Ajay; Sagar, Mala

    2016-01-01

    Background: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). Materials and Methods: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. Results: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. Conclusions: TPB has much greater diagnostic efficacy than CPB. PMID:27169119

  5. Pleural effusion?—Trust your gut

    PubMed Central

    Merali, Shabbir; Zaman, Qazi

    2016-01-01

    A 16-year-old Caucasian male presented with non-specific acute respiratory symptoms, on a background of irritable bowel syndrome and type 2 diabetes mellitus. Clinical examination and initial imaging were highly suggestive of a pleural effusion. Routine confirmatory ultrasound imaging prompted subsequent computed tomography scanning, revealing striking images of a Bochdalek hernia, therefore enabling appropriate subsequent management and avoiding patient harm. PMID:27429917

  6. Mediastinal hemangioma: Masquerading as pleural effusion.

    PubMed

    Deepak, J; Babu, M Narendra; Gowrishankar, B C; Ramesh, S

    2013-10-01

    We present a rare case of mediastinal hemangioma in a 4-year-old child. The child presented with cough and fever and the chest radiograph revealed right pleural effusion. On further work-up with chest computed tomography mediastinal cystic mass occupying the right hemithorax was identified. The cystic mass was resected completely through a right thoracotomy. Histopathological examination established the final diagnosis of mediastinal capillary hemangioma. PMID:24347874

  7. [Asbestos and malignant pleural mesothelioma: molecular, cellular and physiopathological aspects].

    PubMed

    Mohr, Steve; Keith, Gérard; Rihn, Bertrand

    2005-11-01

    Asbestos is known as mutagenic and carcinogenic for human and is responsible for many pulmonary diseases including asbestosis, bronchogenic carcinoma and malignant pleural mesothelioma. Occupational exposure to asbestos is involved in 70-80% of all malignant pleural mesothelioma. The later presents a growing challenge for both researcher and clinician. The diagnosis of malignant pleural mesothelioma is difficult and the current treatments did not show significant improvement of the survival. The increasing incidence of malignant pleural mesothelioma, its gravity and its human, social and financial consequences are of high concern in public health. In this paper we summarize the so far knowledge on cellular, molecular and pathophysiological events involved in genesis and development of malignant pleural mesothelioma. Finally, the paper also report recent data sourced from the study of malignant pleural mesothelioma transcriptome using high-throughput technologies such as gene expression array. These data should improve the accuracy of mesothelioma diagnosis and therapy.

  8. [Ordinary epidemiology: pleural mesothelioma and asbestos].

    PubMed

    Bonazzina, R; Azara, M; Gianera, A; Cannatelli, P; Zocchetti, C

    1997-01-01

    This paper describes a practical experience which took place in a Health District of the Lombardy Region (Northern Italy). This experience was motivated by the publication, on a newspaper, of the results of an epidemiological study which reported the nationwide geographical distribution of the mortality data for pleural mesothelioma during the period 1980-1987. The presence of excesses of pleural mesothelioma cases in two municipalities of Health District captured the attention of some field operators which decided to start working on the topic. Using all information available in the District all cases of pleural mesothelioma occurring during the period 1978-1993 in the two municipalities were identified; possible sources of both occupational and environmental asbestos exposure in the area were identified; and the next-of-kin of the cases was interviewed so as to gain information on the history of possible exposure to asbestos of the cases. For thirteen (out of seventeen) deaths the next-of-kin accepted to be interviewed and for them results are reported: the information presented describes gender, smoking habits, and an evaluation of the potential for exposure to asbestos both of occupational and environmental origin. We discuss the value importance of the experience, with particular emphasis on: a) the routine activities of the Services participating in the study; b) the resources employed; c) the use of epidemiological methods and tools; d) the primary prevention activities originated in the area; e) the personal motivations hat such experiences are capable to convey.

  9. Diagnostic Accuracy of Procalcitonin for Predicting Blood Culture Results in Patients With Suspected Bloodstream Infection

    PubMed Central

    Oussalah, Abderrahim; Ferrand, Janina; Filhine-Tresarrieu, Pierre; Aissa, Nejla; Aimone-Gastin, Isabelle; Namour, Fares; Garcia, Matthieu; Lozniewski, Alain; Guéant, Jean-Louis

    2015-01-01

    Abstract Previous studies have suggested that procalcitonin is a reliable marker for predicting bacteremia. However, these studies have had relatively small sample sizes or focused on a single clinical entity. The primary endpoint of this study was to investigate the diagnostic accuracy of procalcitonin for predicting or excluding clinically relevant pathogen categories in patients with suspected bloodstream infections. The secondary endpoint was to look for organisms significantly associated with internationally validated procalcitonin intervals. We performed a cross-sectional study that included 35,343 consecutive patients who underwent concomitant procalcitonin assays and blood cultures for suspected bloodstream infections. Biochemical and microbiological data were systematically collected in an electronic database and extracted for purposes of this study. Depending on blood culture results, patients were classified into 1 of the 5 following groups: negative blood culture, Gram-positive bacteremia, Gram-negative bacteremia, fungi, and potential contaminants found in blood cultures (PCBCs). The highest procalcitonin concentration was observed in patients with blood cultures growing Gram-negative bacteria (median 2.2 ng/mL [IQR 0.6–12.2]), and the lowest procalcitonin concentration was observed in patients with negative blood cultures (median 0.3 ng/mL [IQR 0.1–1.1]). With optimal thresholds ranging from ≤0.4 to ≤0.75 ng/mL, procalcitonin had a high diagnostic accuracy for excluding all pathogen categories with the following negative predictive values: Gram-negative bacteria (98.9%) (including enterobacteria [99.2%], nonfermenting Gram-negative bacilli [99.7%], and anaerobic bacteria [99.9%]), Gram-positive bacteria (98.4%), and fungi (99.6%). A procalcitonin concentration ≥10 ng/mL was associated with a high risk of Gram-negative (odds ratio 5.98; 95% CI, 5.20–6.88) or Gram-positive (odds ratio 3.64; 95% CI, 3.11–4.26) bacteremia but

  10. Management of infectious processes of the pleural space: a review.

    PubMed

    Girdhar, Ankur; Shujaat, Adil; Bajwa, Abubakr

    2012-01-01

    Pleural effusions can present in 40% of patients with pneumonia. Presence of an effusion can complicate the diagnosis as well as the management of infection in lungs and pleural space. There has been an increase in the morbidity and mortality associated with parapneumonic effusions and empyema. This calls for employment of advanced treatment modalities and development of a standardized protocol to manage pleural sepsis early. There has been an increased understanding about the indications and appropriate usage of procedural options at clinicians' disposal.

  11. Pleural Nocardiosis in an Immunocompetent Patient: A Case Report

    PubMed Central

    Mantur, Prakash

    2016-01-01

    Nocardiosis is a rare infection that has attracted attention with its increased rate of occurrence in the recent years. In India there is a rare documentation of the pleural involvement in nocardiosis. We report here a case of pleural nocardiosis caused by Nocardia brasiliensis in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pleural lesions. PMID:26894067

  12. Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies.

    PubMed

    Liew, Y X; Lee, W; Cai, Y Y; Teo, J; Tang, S S-L; Ong, R W-Q; Lim, C L-L; Lingegowda, P B; Kwa, A L-H; Chlebicki, M P

    2012-11-01

    As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.

  13. The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula

    PubMed Central

    Noh, Dongsub; Park, Chang-Kwon

    2016-01-01

    Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy. PMID:27066439

  14. Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG).

    PubMed

    Geltner, Christian; Errhalt, Peter; Baumgartner, Bernhard; Ambrosch, Gerhard; Machan, Barbara; Eckmayr, Josef; Klikovits, Thomas; Hoda, Mir Alireza; Popper, Helmut; Klepetko, Walter

    2016-09-01

    Malignant pleural mesothelioma is a rare malignant disease that in the majority of cases is associated with asbestos exposure. The incidence in Europe is about 20 per million inhabitants and it is increasing worldwide. Initial symptoms are shortness of breath, pleural effusion, cough, and chest pain. The typical growth pattern is along the pleural surface; however, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage. Ultimately, distant metastases outside the chest can result. Several histological subtypes of pleural mesothelioma exist, which must be differentiated from either benign diseases or metastases in the pleural space by other tumor entities. This differential diagnosis can be very difficult and a large panel of immunohistochemical markers is required to establish the exact diagnosis. The standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis is videothoracoscopy. Full thickness biopsies are required, while transthoracic needle puncture of pleural fluid or tissue is considered to be insufficient for a cytological diagnosis. Complete and detailed staging is mandatory for categorization of the disease as well as for therapeutic decision making.

  15. Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG).

    PubMed

    Geltner, Christian; Errhalt, Peter; Baumgartner, Bernhard; Ambrosch, Gerhard; Machan, Barbara; Eckmayr, Josef; Klikovits, Thomas; Hoda, Mir Alireza; Popper, Helmut; Klepetko, Walter

    2016-09-01

    Malignant pleural mesothelioma is a rare malignant disease that in the majority of cases is associated with asbestos exposure. The incidence in Europe is about 20 per million inhabitants and it is increasing worldwide. Initial symptoms are shortness of breath, pleural effusion, cough, and chest pain. The typical growth pattern is along the pleural surface; however, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage. Ultimately, distant metastases outside the chest can result. Several histological subtypes of pleural mesothelioma exist, which must be differentiated from either benign diseases or metastases in the pleural space by other tumor entities. This differential diagnosis can be very difficult and a large panel of immunohistochemical markers is required to establish the exact diagnosis. The standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis is videothoracoscopy. Full thickness biopsies are required, while transthoracic needle puncture of pleural fluid or tissue is considered to be insufficient for a cytological diagnosis. Complete and detailed staging is mandatory for categorization of the disease as well as for therapeutic decision making. PMID:27619223

  16. Clinical diagnostic of pleural effusions using a high-speed viscosity measurement method

    NASA Astrophysics Data System (ADS)

    Hurth, Cedric; Klein, Katherine; van Nimwegen, Lena; Korn, Ronald; Vijayaraghavan, Krishnaswami; Zenhausern, Frederic

    2011-08-01

    We present a novel bio-analytical method to discriminate between transudative and exudative pleural effusions based on a high-speed video analysis of a solid glass sphere impacting a liquid. Since the result depends on the solution viscosity, it can ultimately replace the battery of biochemical assays currently used. We present results obtained on a series of 7 pleural effusions obtained from consenting patients by analyzing both the splash observed after the glass impactor hits the liquid surface, and in a configuration reminiscent of the drop ball viscometer with added sensitivity and throughput provided by the high-speed camera. The results demonstrate distinction between the pleural effusions and good correlation with the fluid chemistry analysis to accurately differentiate exudates and transudates for clinical purpose. The exudative effusions display a viscosity around 1.39 ± 0.08 cP whereas the transudative effusion was measured at 0.89 ± 0.09 cP, in good agreement with previous reports.

  17. Unilateral pleural effusion without ascites in liver cirrhosis

    SciTech Connect

    Faiyaz, U.; Goyal, P.C.

    1983-09-01

    The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.

  18. High IL-35 Pleural Expression in Patients with Tuberculous Pleural Effusion

    PubMed Central

    Dong, Xuan; Yang, Jiong

    2015-01-01

    Background IL-35 is a novel anti-inflammatory and immunosuppressive cytokine primarily produced by Treg cells, and is involved in inflammatory diseases and autoimmune diseases. However, its roles in tuberculous pleural effusion (TPE) remain unknown. We aimed to investigate the potential involvement of IL-35 in TPE. Material/Methods Thirty TPE patients and 20 lung cancer patients with malignant pleural effusion (MPE) were recruited. Samples of pleural effusion (100 mL) were collected after traditional pleurocentesis. Blood was sampled from TPE patients. Mononuclear cells were isolated by Ficoll-Hypaque gradient. Proportions of Th1, Th17, and IL-35-producing cells were analyzed by flow cytometry. IL-35 was assessed by real-time RT-PCR, ELISA, and immunofluorescence. An ELISPOT assay was used to assess the effect of IL-35 on pleural effusion mononuclear cells (PEMCs). Results Proportions of IL-35-producing cells were higher in TPE compared with MPE (49.4±6.0 vs. 15.8±5.4%, P<0.001) and blood from TPE patients (49.4±6.0% vs. 16.6±3.1, P<0.001). IL-35, IL-17 and IFN-γ were elevated in TPE compared with MPE (all P<0.01). ELISPOT assay showed that IL-35 reduced the proportion of IFN-γ-producing CD4+ T cells in TPE. IL-35 mRNA expression was higher in TPE compared with MPE (P<0.001). Immunofluorescence showed that IL-35-positive cells were present in pleural tissues from TPE patients. Conclusions Results suggest that there is an imbalance in IL-35 metabolism in TPE. However, further studies are required to assess the exact relationship with the immune system response to tuberculosis. IL-35 might play a role in TPE and might be targeted as a treatment for TPE. PMID:25935866

  19. A RARE CASE OF PLEURAL LYMPHOMA

    PubMed Central

    Basuthakur, Sumitra; Sarkar, Anirban; Burman, Sushanta; Dandale, Rajesh

    2008-01-01

    We present a case report of a 20 years old male who had low grade fever, weight loss of about 10 kg and left-sided chest pain increasing in intensity over a year. Clinically, it mimicked left sided pleural effusion with a tender, soft, parietal swelling in left in-fraaxillary area. Chest x-ray and Computerized Tomography-scan of thorax showed pleura based mass in left hemi thorax. Computerized Tomography guided Fine Needle Aspiration Cytology confirmed the diagnosis of non Hodgkin Lymphoma, diffuse large B cell type, high-grade. PMID:21264085

  20. Pleurodesis outcome in malignant pleural mesothelioma.

    PubMed

    Fysh, Edward Thomas Hamilton; Tan, Sze Khen; Read, Catherine Ann; Lee, Felicity; McKenzie, Kate; Olsen, Nola; Weerasena, Indunil; Threlfall, Timothy; de Klerk, Nicholas; Musk, A William; Lee, Y C Gary

    2013-06-01

    Few data exist on the pleurodesis outcome in patients with malignant pleural mesothelioma (MPM). A retrospective review of the Western Australian Mesothelioma Registry over 5 years revealed 390 evaluable patients. Only a subset of patients (42.3%) underwent pleurodesis, surgically (n=78) or by bedside instillation of sclerosants (n=87). Surgical pleurodesis showed no advantages over bedside pleurodesis in efficacy (32% vs 31% failures requiring further drainage, p=0.98), patient survival (p=0.52) or total time spent in hospital from procedure till death (p=0.36). No clinical, biochemical or radiographic parameters tested adequately predict pleurodesis outcome.

  1. [Epidemiologic surveillance of pleural mesothelioma in Italy].

    PubMed

    Vetrugno, T; Comba, P; Savelli, D; Belli, S; Magnani, C

    1991-01-01

    A collaborative study has been performed in order to detect cases of pleural mesothelioma diagnosed or treated in Italy in the years 1984-88. Cases have been notified to ISS by 88 centres (clinics of thoracic surgery and respiratory diseases, oncologic centres, institutes of pathology), active in 14 Italian regions. Altogether, 575 cases (415 males and 160 females) have been included in the study. Information on occupation and/or on non occupational exposure to asbestos was available for 65% of the subjects, and the occurrence of definite or possible exposure to asbestos was estimated for 58% of them.

  2. Surface plasmon resonance-based immunoassay for procalcitonin.

    PubMed

    Vashist, Sandeep Kumar; Schneider, E Marion; Barth, Eberhard; Luong, John H T

    2016-09-28

    A surface plasmon resonance (SPR) biosensor has been developed for rapid immunoassay of procalcitonin (PCT) with high detection sensitivity and reproducibility. The 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride (EDC)-activated protein A (PrA), diluted in 1% (v/v) 3-aminopropyltriethoxysilane (APTES) was dispensed on a KOH-treated Au-coated SPR chip, resulting in the covalent binding of PrA in 30 min. This "single-step" PrA immobilization strategy led to the oriented binding of the anti-PCT antibody (Ab) on a PrA-functionalized gold (Au) chip. The leach-proof immobilization procedure is five-fold faster than conventional counterparts, enabling high detection specificity and reproducibility. The IA detects 4-324 ng mL(-1) of PCT with a limit of detection (LOD) and a limit of quantification (LOQ) of 4.2 ng mL(-1) and 9.2 ng mL(-1), respectively. It was capable of detecting PCT in real sample matrices and patient samples with high precision. The Ab-bound SPR chips were stable for more than five weeks.

  3. Use of procalcitonin in clinical oncology: a literature review.

    PubMed

    Sbrana, Andrea; Torchio, Martina; Comolli, Giuditta; Antonuzzo, Andrea; Danova, Marco

    2016-09-01

    The use of procalcitonin (PCT) as an early marker of infectious episodes in cancer patients is still controversial. We performed a MEDLINE search of peer-reviewed articles published between January 1990 and December 2015, and finally we analysed 15 articles. PCT seems to have a good diagnostic value of infectious episodes in cancer patients and its accuracy seems greater if we consider major events, such as bloodstream infections and sepsis. Serial evaluations of this protein seem to be more accurate in the diagnostic phase and useful to predict outcome and response to antibacterial treatment. On the other hand, some issues have yet to be solved, such as the use of a validated method of determination, the definition of a standard cut-off, and the heterogeneity among different settings of patients (e.g. early versus advanced-stage cancer, or haematological versus solid tumours). However, it is credible to think that PCT use in everyday clinical practice, preferably in combination with other clinical or laboratory tests, might be of help in finding and detecting early infectious complications in cancer patients. PMID:27602414

  4. Procalcitonin in bacterial infections--hype, hope, more or less?

    PubMed

    Christ-Crain, Mirjam; Müller, Beat

    2005-08-01

    An ideal marker for bacterial infections should allow an early diagnosis, inform about the course and prognosis of the disease and facilitate therapeutic decisions. Procalcitonin (ProCT) covers these features better as compared to other, more commonly used biomarkers, and thus, the current hype on ProCT has a solid scientific basis. A superior diagnostic accuracy of ProCT has been shown for a variety of infections, eg respiratory tract infections, meningitis, acute infectious endocarditis and pancreatitis. Importantly, a ProCT-based therapeutic strategy can safely and markedly reduce antibiotic usage in lower respiratory tract infections, the major cause of sepsis. Being a hormokine mediator, immunoneutralisation of ProCT might offer new hope for more effective treatment options in sepsis. It is now evidence-based that ProCT provides more information and, thereby, questions the currently used "gold standards" for the diagnosis of clinically relevant bacterial infections. Yet, ProCT is less than a perfect marker. ProCT can be increased in non-infectious conditions, and may remain low in infections. The diagnosis of bacterial infections will continue to require a critical clinical awareness, careful patient history, dedicated physical examination, and appropriate cultures. This review aims to help the clinician to understand the physiopathological basis, to appreciate strengths and weaknesses of this biomarker, and thereby to promote a rational implementation of ProCT in a routine setting.

  5. Surface plasmon resonance-based immunoassay for procalcitonin.

    PubMed

    Vashist, Sandeep Kumar; Schneider, E Marion; Barth, Eberhard; Luong, John H T

    2016-09-28

    A surface plasmon resonance (SPR) biosensor has been developed for rapid immunoassay of procalcitonin (PCT) with high detection sensitivity and reproducibility. The 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride (EDC)-activated protein A (PrA), diluted in 1% (v/v) 3-aminopropyltriethoxysilane (APTES) was dispensed on a KOH-treated Au-coated SPR chip, resulting in the covalent binding of PrA in 30 min. This "single-step" PrA immobilization strategy led to the oriented binding of the anti-PCT antibody (Ab) on a PrA-functionalized gold (Au) chip. The leach-proof immobilization procedure is five-fold faster than conventional counterparts, enabling high detection specificity and reproducibility. The IA detects 4-324 ng mL(-1) of PCT with a limit of detection (LOD) and a limit of quantification (LOQ) of 4.2 ng mL(-1) and 9.2 ng mL(-1), respectively. It was capable of detecting PCT in real sample matrices and patient samples with high precision. The Ab-bound SPR chips were stable for more than five weeks. PMID:27619095

  6. Nanoimprinted nanopillar array chip for procalcitonin detection (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Sun, Ling Ling; Zhou, Xiaodong

    2016-03-01

    Procalcitonin (PCT) is an early and highly specific biomarker in response to bacterial infection. The PCT-guided antibiotic therapy has demonstrated to be more efficient than standard therapy to reduce in antibiotic use without adverse outcome in mortality. The PCT detection in clinics is required to be highly sensitive with a sensitivity of 0.5 ng/ml. At present, the technologies for PCT detection are limited. This paper reported a highly sensitive nanoimprinted gold nanopillar array chip for PCT detection. To achieve high sensitivity for PCT detection, the gold nanopillar array sensing chip was designed by plasmonic simulation and fabricated by high fidelity nanoimprinting technology. The gold nanopillars of 140 nm were nanoimprinted on glass substrate. A robust sandwich bioassay of capture antibody /PCT / quantum dot (QD) conjugated detection antibody was established on the gold nanopillar array chip to detect PCT. The nanopillars serve as localized surface plasmon resonance (LSPR) generators to enhance the fluorescent emission from QD. A limit of detection (LOD) of 0.5 ng/ml was achieved for PCT detection. This is the first time that PCT is detected with such high sensitivity by LSPR enhanced QD emission. By considering the low-cost, high sensitivity of the bioassay, as well as the inexpensive mass fabrication of the high quality chips, this novel nanoimprinted gold nanopillar array chip is particularly useful for developing a point-of-care system for PCT detection.

  7. Superior vena caval pressure elevation causes pleural effusion formation in sheep.

    PubMed

    Allen, S J; Laine, G A; Drake, R E; Gabel, J C

    1988-09-01

    The effect of superior vena caval pressure (SVCP) elevation on the formation of pleural effusions (PE) was studied in sheep. Through a right thoracotomy, a Silastic cuff was placed around the superior vena cava. Catheters for monitoring SVCP and pulmonary artery pressure (PAP) were also placed. After a 1- to 3-wk recovery period, we measured the SVCP, PAP, cardiac output, and plasma protein concentration (Cp). We then elevated the SVCP to various levels from base line [5.3 +/- 2.6 (SD) mmHg] to 33 mmHg. The cardiac output, PAP, and Cp were remeasured 1-2 h and 24 h after SVCP elevation. At the end of the 24-h period, the animals were killed. The PE volume and pleural fluid protein concentration (Cpl) were measured, and the Cpl/Cp was calculated. PE generally did not occur until the SVCP was elevated above 15 mmHg. To study the effect of the thoracotomy on the subsequent pleural effusion, we studied six additional sheep in which we did not perform a thoracotomy. In these animals, the SVCP was elevated to between 5 and 28 mmHg for 24 h by use of a 16-Fr balloon catheter placed via a left external jugular vein and a right carotid-external jugular shunt. We found that the PE volume, for a given SVCP elevation, was similar to that present in sheep that received a thoracotomy. For all sheep the volume of PE was related to SVCP by the equation PE (ml) = 0.24e0.26SVCP, r = 0.85. In the sheep without a thoracotomy, Cpl/Cp rose with increasing volume of PE. Our data demonstrate that elevation of SVCP greater than 15 mmHg for 24 h results in the formation of PE. The rise in Cpl/Cp with PE volume suggests that filtration through the pleural vessels is not the major contributor to PE formation. PMID:3414816

  8. The diagnostic utility and tendency of the soluble receptor for advanced glycation end products (sRAGE) in exudative pleural effusion

    PubMed Central

    Sim, Yun Su; Kim, Dong Gyu

    2016-01-01

    Background The soluble receptor for advanced glycation end products (sRAGE) may have an inflammatory or homeostatic function in lung tissue. The aim of this study was to assess the usefulness of sRAGE as a diagnostic marker for exudative pleural effusions, which are common manifestations of a variety of diseases. Methods Patients with an undiagnosed pleural effusion were prospectively enrolled between January 2013 and January 2015. Samples of blood and pleural fluid were centrifuged and the supernatant stored at −70 °C. The levels of sRAGE in serum and pleural fluid were determined using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Results In total 47 patients, 21 patients were diagnosed with a tuberculous effusion, and the groups diagnosed with parapneumonic or malignant effusions comprised 13 patients each. The serum sRAGE levels for tuberculosis were significantly elevated [median, 1,291 pg/mL; interquartile range (IQR), 948–1,711 pg/mL] when compared with those for both pneumonia (median, 794 pg/mL; IQR, 700–1,255 pg/mL) and lung cancer (median, 886 pg/mL; IQR, 722–1,285 pg/mL) (P=0.029). The pleural sRAGE levels for pneumonia (median, 1,763 pg/mL; IQR, 1,262–4,431 pg/mL) were lower than those for both tuberculosis (median, 5,081 pg/mL; IQR, 3,300–6,004 pg/mL) and lung cancer (median, 4,936 pg/mL; IQR, 3,282–7,018 pg/mL) (P=0.009) The receiver operating characteristic (ROC) curve analysis selected 896 pg/mL as the best cutoff value in the sRAGE serum level for tuberculosis [sensitivity, 86%; specificity 58%; area under the curve (AUC) =0.727, P=0.008]. For the pleural effusion sRAGE level, the ROC curve analysis selected 2,231 pg/mL as the best cutoff value for pneumonia (sensitivity, 91%; specificity, 62%, AUC =0.792, P=0.002). Conclusions Among patients with exudative effusion, pleural and serum sRAGE measurements may be useful supportive diagnostic tools in the evaluation of ambiguous pleural effusion. Furthermore

  9. [Diagnosis delay of pleural and pulmonary tuberculosis].

    PubMed

    Cherif, J; Mjid, M; Ladhar, A; Toujani, S; Mokadem, S; Louzir, B; Mehiri, N; Béji, M

    2014-08-01

    Tuberculosis (TB) is still being endemic in our country. Time until management determines both evolution and prognosis of this condition. The aim of this work is to evaluate the delay in diagnosis of TB in a respiratory unit from a university hospital series. The authors conducted a cross-sectional study including patients with pulmonary TBC and/or pleural. An evaluation of time management was conducted from the beginning of symptoms and various consultations with reference to the date of hospitalization and treatment set up. One hundred patients were included (pulmonary TB: 68 cases, pleural TB 23 cases, miliary pulmonary TB: 4 cases, pulmonary TB associated with other extrathoracic locations: 5 cases). The mean time of patient delay and total delay institution were respectively 43.6, 25.7 and 69.3 days. Variables responsible for long delays were: number of consultations more than 3 before hospitalization, empirical antibiotic therapy, of a regional hospital first consultation and the presence of extra-respiratory impairment. The patient delay was considered long. A reorganization of the TB control program, in particular by partial decentralization of care and health education is imperative in order to improve the quality of tuberculosis management in our country.

  10. Serum PDGF-AB in pleural mesothelioma.

    PubMed

    Filiberti, Rosa; Marroni, Paola; Neri, Monica; Ardizzoni, Andrea; Betta, Pier Giacomo; Cafferata, Mara A; Canessa, Pier Aldo; Puntoni, Riccardo; Ivaldi, Giovanni Paolo; Paganuzzi, Michela

    2005-01-01

    Overexpression of platelet-derived growth factor (PDGF) has been observed in lung and pleural tumors. The aim of this study was to evaluate the diagnostic and prognostic role of serum PDGF in pleural mesothelioma (PM). Four groups of subjects were studied: 93 malignant PM patients, 33 primary non small cell lung cancer patients, 51 subjects exposed to asbestos, defined as high-risk controls, and 24 healthy controls. PDGF-AB mean concentration was higher in PM patients (45.8 ng/ml) than in high-risk controls (33.1 ng/ml) and healthy controls (26.8 ng/ml). Using the cut-off level of 49.8 ng/ml, corresponding to the mean+2SD of PDGF-AB in healthy controls, 43% of PM patients showed positive PDGF-AB levels. Survival was evaluated in 82 PM patients. At the end of the follow-up (median 9.8 months) 80.5% of patients had died. Median survival was 13.1 and 7.9 months for patients with PDGF-AB lower and higher than the cut-off, respectively. Adjusting for age, sex, histology and platelet count, positive PDGF-AB levels were associated with lower survival (OR=1.2, 95%CI: 0.9-1.6), even if not significantly so. In conclusion, serum PDGF may represent a useful additional parameter to prognostic factors already available for PM.

  11. Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock.

    PubMed

    Huang, Min-Yi; Chen, Chun-Yu; Chien, Ju-Huei; Wu, Kun-Hsi; Chang, Yu-Jun; Wu, Kang-Hsi; Wu, Han-Ping

    2016-01-01

    We evaluated the tendency of the plasma concentration and procalcitonin (PCT) clearance (PCTc) to act as biomarkers of prognosis in patients with severe sepsis and septic shock. From 2011 to 2013, we prospectively analyzed patients with sepsis admitted to the intensive care unit (ICU). The serum PCT was evaluated at the time of sepsis diagnosis and again after 48 h (day 3) and 96 h (day 5). PCTc after 48 h (PCTc-day 3) and 96 h (PCTc-day 5) was also calculated to evaluate the prognostic value for survival in patients with sepsis. A total of 48 patients were included. Overall mortality was 16.7% (8 patients). PCTc was higher in survivors than in nonsurvivors, with significant differences on day 3 and day 5 (p = 0.033; p = 0.002, resp.); however, serum PCT levels on day 1, day 3, and day 5 were not significant prognostic factors for survival. The prognosis of patients with severe sepsis and septic shock may be associated with PCTc. Dynamic changes of PCT reflected as PCTc at 48 h (day 3) and 96 h (day 5) after admission to the ICU may serve as a predictor of survival in critically ill patients with severe sepsis. PMID:27088084

  12. Microfluidic purification and concentration of malignant pleural effusions for improved molecular and cytomorphological diagnostics.

    PubMed

    Che, James; Mach, Albert J; Go, Derek E; Talati, Ish; Ying, Yong; Rao, Jianyu; Kulkarni, Rajan P; Di Carlo, Dino

    2013-01-01

    Evaluation of pleural fluids for metastatic cells is a key component of diagnostic cytopathology. However, a large background of smaller leukocytes and/or erythrocytes can make accurate diagnosis difficult and reduce specificity in identification of mutations of interest for targeted anti-cancer therapies. Here, we describe an automated microfluidic system (Centrifuge Chip) which employs microscale vortices for the size-based isolation and concentration of cancer cells and mesothelial cells from a background of blood cells. We are able to process non-diluted pleural fluids at 6 mL/min and enrich target cells significantly over the background; we achieved improved purity in all patient samples analyzed. The resulting isolated and viable cells are readily available for immunostaining, cytological analysis, and detection of gene mutations. To demonstrate the utility towards aiding companion diagnostics, we also show improved detection accuracy of KRAS gene mutations in lung cancer cells processed using the Centrifuge Chip, leading to an increase in the area under the curve (AUC) of the receiver operating characteristic from 0.90 to 0.99. The Centrifuge Chip allows for rapid concentration and processing of large volumes of bodily fluid samples for improved cytological diagnosis and purification of cells of interest for genetic testing, which will be helpful for enhancing diagnostic accuracy. PMID:24205153

  13. Pro/Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients?

    PubMed Central

    Shehabi, Yahya; Seppelt, Ian

    2008-01-01

    You are concerned about the escalating use of antibiotics in your intensive care unit (ICU). This has put a strain on the ICU budget and is possibly resulting in the emergence of resistant bacteria. You review the situation with your team and one suggestion is to consider using biomarkers such as procalcitonin to better guide appropriate antibiotic decision making. PMID:18466649

  14. 77 FR 34389 - Determination of Regulatory Review Period for Purposes of Patent Extension; Progel Pleural Air...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-11

    ... Patent Extension; Progel Pleural Air Leak Sealant AGENCY: Food and Drug Administration, HHS. ACTION... Progel Pleural Air Leak Sealant and is publishing this notice of that determination as required by law... device, Progel Pleural Air Leak Sealant. Progel Pleural Air Leak Sealant is indicated for application...

  15. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions

    PubMed Central

    Patil, Chetan Basavaraj; Dixit, Ramakant; Gupta, Rakesh; Gupta, Neeraj; Indushekar, Varna

    2016-01-01

    Background: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. Materials and Methods: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope. Clinical, radiological, cyto and histopathological data of the patients were collected prospectively and analyzed. Results: The overall diagnostic yield of thoracoscopic pleural biopsy was 110/129 (85.2%) in patients with undiagnosed pleural effusion, and 19/129 (14.8%) patients remained unexplained. Histopathological diagnosis confirmed malignancy in 66.4% patients (both primary and metastatic pleural carcinoma), tuberculosis in 28.2%, others including parapneumonic effusion in 4 cases followed by multiple myeloma, lupus pleuritis, and pulmonary langerhans cell histiocytosis in one case each. Procedure-related mortality was nil. Minor complications related to the procedure include hemorrhage, subcutaneous emphysema, etc. Conclusion: Thoracoscopy is relatively a safe and well-tolerated procedure with high diagnostic accuracy in undiagnosed pleural effusions, decreasing the need of formal diagnostic thoracotomy. Every chest physician must, therefore, consider this procedure to decrease the time lag in achieving the final diagnosis and to initiate the treatment as early as possible. PMID:27625443

  16. Prevention of Pleural Adhesions by Bioactive Polypeptides - A Pilot Study

    PubMed Central

    Åkerberg, D.; Posaric-Bauden, M.; Isaksson, K.; Andersson, R.; Tingstedt, B.

    2013-01-01

    Objective: Postoperative pleural adhesions lead to major problems in repeated thoracic surgery. To date, no antiadhesive product has been proven clinically effective. Previous studies of differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG) have shown promising results reducing postoperative abdominal adhesions in experimental settings. This pilot study examined the possible pleural adhesion prevention by using the PL+PG concept after pleural surgery and its possible effect on key parameters; plasmin activator inhibitor-1 (PAI-1) and tissue growth factor beta 1 (TGFb) in the fibrinolytic process. Methods: A total of 22 male rats were used in the study, one control group (n=10) and one experimental group (n=12). All animals underwent primary pleural surgery, the controls receiving saline in the pleural cavity and the experimental group the PL+PG solution administered by spray. The animals were evaluated on day 7. Macroscopic appearance of adhesions was evaluated by a scoring system. Histology slides of the adhesions and pleural biopsies for evaluation of PAI-1 and TGFb1 were taken on day 7. Results: A significant reduction of adhesions in the PL+PG group (p<0.05) was noted at day 7 both regarding the length and severity of adhesions. There were no significant differences in the concentration of PAI-1 and TGFb1 when comparing the two groups. Conclusions: PL+PG may be used to prevent pleural adhesions. The process of fibrinolysis, and fibrosis was though not affected after PLPG administration. PMID:24151443

  17. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions

    PubMed Central

    Patil, Chetan Basavaraj; Dixit, Ramakant; Gupta, Rakesh; Gupta, Neeraj; Indushekar, Varna

    2016-01-01

    Background: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. Materials and Methods: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope. Clinical, radiological, cyto and histopathological data of the patients were collected prospectively and analyzed. Results: The overall diagnostic yield of thoracoscopic pleural biopsy was 110/129 (85.2%) in patients with undiagnosed pleural effusion, and 19/129 (14.8%) patients remained unexplained. Histopathological diagnosis confirmed malignancy in 66.4% patients (both primary and metastatic pleural carcinoma), tuberculosis in 28.2%, others including parapneumonic effusion in 4 cases followed by multiple myeloma, lupus pleuritis, and pulmonary langerhans cell histiocytosis in one case each. Procedure-related mortality was nil. Minor complications related to the procedure include hemorrhage, subcutaneous emphysema, etc. Conclusion: Thoracoscopy is relatively a safe and well-tolerated procedure with high diagnostic accuracy in undiagnosed pleural effusions, decreasing the need of formal diagnostic thoracotomy. Every chest physician must, therefore, consider this procedure to decrease the time lag in achieving the final diagnosis and to initiate the treatment as early as possible.

  18. [Hyperthermic chemoperfusion of the pleural cavity in the combined treatment for malignant pleural mesothelioma].

    PubMed

    Levchenko, E V; Mamontov, O Iu; Senchik, K Iu; Barchuk, A S; Gel'fond, M L

    2014-01-01

    The literature and our own experience were analyzed in multimodal approach to the treatment of patients with malignant pleural mesothelioma (MPM). Survival and quality of life of patients with MPM who underwent multimodal treatment, according to modern standards, are often limited by the occurrence of local recurrences. The value of a number of local therapy methods is still being explored in order to determine the possible side effects as well as the duration of disease-free survival. Photodynamic therapy and intraoperative hyperthermic chemoperfusion of the pleural cavity are the methods of the local treatment of this disease, applied after surgery. These approaches have been investigated separately in several studies, but their efficacy and tolerability is still not clear. The authors wanted to find the best indications for the use of these methods and to assess the immediate and long-term results. PMID:25552068

  19. Serum Procalcitonine Levels as an Early Diagnostic Indicator of Sepsis

    PubMed Central

    Beqja-Lika, Anila; Bulo-Kasneci, Anyla; Refatllari, Etleva; Heta-Alliu, Nevila; Rucaj-Barbullushi, Alma; Mone, Iris; Mitre, Anila

    2013-01-01

    Introduction: Prompt and accurate diagnosis of sepsis is of high importance for clinicians. Procalcitonine (PCT) and C-reactive protein (CRP) have been proposed as markers for this purpose. Our aim was to evaluate the levels of PCT and CRP in early sepsis and its correlation with severity of sepsis. Methods: Levels of PCT and CRP were taken from 60 patients with sepsis criteria and 39 patients with SIRS symptoms from the University Hospital Center “Mother Teresa” in Tirana, Albania during 2010-2012. Sensitivity, specificity and predictive values for PCT and CRP were calculated. Results: PCT and CRP levels increased in parallel with the severity of the clinical conditions of the patients. The mean PCT level in patients with sepsis was 11.28 ng/ml versus 0.272 ng/ml in patients with SIRS symptoms, with a sensitivity of 97.4% and a specificity of 96.6% for PCT >0.5ng/ml. The mean CRP level in septic patients was 146.58 mg/l vs. 34.4 mg/l in patients with SIRS, with a sensitivity of 98.6% for sepsis and a specificity of 75 % for CRP >11mg/l. Conclusion: PCT and CRP values are useful markers to determine early diagnosis and severity of an infection. In the present study, PCT was found to be a more accurate diagnostic parameter for differentiating SIRS from sepsis and may be helpful in the follow-up of critically ill patients. PMID:23687457

  20. Early prediction of renal parenchymal injury with serum procalcitonin

    PubMed Central

    Barati, Leila; Safaeian, Baranak; Mehrjerdian, Mahshid; Vakili, Mohammad-Ali

    2016-01-01

    Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in children that can be associated with renal parenchymal injuries and late scars. Dimercaptosuccinic acid (DMSA) renal scan is known as golden standard for detecting acute pyelonephritis (APN) that has a lot of difficulties and limitations. Objectives: we designed this study the accuracy of one inflammatory marker, serum procalcitonin (PCT) to identify as an early predictor of renal injuries. Patients and Methods: A prospective study was carried out in 95 patients who admitted in the hospital with the first febrile UTI. Serum PCT of all patients was measured; sensitivity, specificity, positive and negative predictive value (PPV and NPV) of this marker was analyzed compared to DMSA scan. P value <0.05 was taken as significant. Results: In total, 79 females and 16 males were investigated. There are 42 cases in group 1 with normal DMSA scan and 53 patients in group two with renal parenchymal injuries in their scans. Mann-Whitney test showed a meaningful relation between the two groups regarding PCT level (P<0.0001). Sensitivity, specificity, PPV and NPV of PCT reported in optimum cut off were 70%, 88.1%, 88.1% and 70%, respectively. The positive likelihood ratio (PLR) of PCT test was 5.8. Conclusion: In the current survey, PCT was the eligible inflammatory marker to predict renal parenchymal injuries in children with proper sensitivity, specificity, PPV and NPV that play also a pivotal role in the children aged less than 24 months, although, more studies should be undertaken to confirm. PMID:27689104

  1. Early prediction of renal parenchymal injury with serum procalcitonin

    PubMed Central

    Barati, Leila; Safaeian, Baranak; Mehrjerdian, Mahshid; Vakili, Mohammad-Ali

    2016-01-01

    Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in children that can be associated with renal parenchymal injuries and late scars. Dimercaptosuccinic acid (DMSA) renal scan is known as golden standard for detecting acute pyelonephritis (APN) that has a lot of difficulties and limitations. Objectives: we designed this study the accuracy of one inflammatory marker, serum procalcitonin (PCT) to identify as an early predictor of renal injuries. Patients and Methods: A prospective study was carried out in 95 patients who admitted in the hospital with the first febrile UTI. Serum PCT of all patients was measured; sensitivity, specificity, positive and negative predictive value (PPV and NPV) of this marker was analyzed compared to DMSA scan. P value <0.05 was taken as significant. Results: In total, 79 females and 16 males were investigated. There are 42 cases in group 1 with normal DMSA scan and 53 patients in group two with renal parenchymal injuries in their scans. Mann-Whitney test showed a meaningful relation between the two groups regarding PCT level (P<0.0001). Sensitivity, specificity, PPV and NPV of PCT reported in optimum cut off were 70%, 88.1%, 88.1% and 70%, respectively. The positive likelihood ratio (PLR) of PCT test was 5.8. Conclusion: In the current survey, PCT was the eligible inflammatory marker to predict renal parenchymal injuries in children with proper sensitivity, specificity, PPV and NPV that play also a pivotal role in the children aged less than 24 months, although, more studies should be undertaken to confirm.

  2. Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

    PubMed Central

    Mierzchała-Pasierb, Magdalena; Durek, Grażyna

    2016-01-01

    Introduction Severe sepsis and septic shock are advanced clinical conditions representing the patient's response to infection and having a variable but high mortality rate. Early evaluation of sepsis stage and choice of adequate treatment are key factors for survival. Some study results suggest the necessity of daily procalcitonin (PCT) monitoring because of its prognostic and discriminative value. Material and methods An observational and prospective study was conducted to evaluate the prognostic and discriminative value of PCT kinetics in comparison to PCT absolute value measurements. In a group of 50 intensive care unit patients with diagnosis of severe sepsis or septic shock, serum PCT measurements were performed on admission, and on the 2nd, 3rd and 5th day of therapy. The level of PCT was determined with a commercially available test according to the manufacturer's protocol. Results The kinetics of PCT assessed by ΔPCT was statistically significant in the survivors vs. the non-survivors subgroup (ΔPCT3/1, p = 0.022; ΔPCT5/1, p = 0.021). ΔPCT has no statistical significance in the severe sepsis and septic shock subgroups for all analyzed days. Only the 5th day PCT level was significantly higher in the non-survivors vs. survivors group (p = 0.008). The 1st day PCT level in the severe sepsis vs. septic shock group has a discriminative impact (p = 0.009). Conclusions According to the results, single serum PCT measurement, regardless of absolute value, has a discriminative impact but no prognostic significance, during the first 2 days of therapy. The PCT kinetics is of prognostic value from the 3rd day and is of earlier prognostic significance in comparison to changes in the patient's clinical condition evaluated by SOFA score kinetics. PMID:26925126

  3. Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

    PubMed Central

    Chen, Kuan-Yuan; Feng, Po-Hao; Chang, Chih-Cheng; Chen, Tzu-Tao; Chuang, Hsiao-Chi; Lee, Chun-Nin; Su, Chien-Ling; Lin, Lian-Yu; Lee, Kang-Yun

    2016-01-01

    Lymphocytic pleurisy is commonly observed in tuberculosis and cancer. Noninvasive biomarkers are needed to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE) because current clinical diagnostic procedures are often invasive. We identified immune response biomarkers that can discriminate between TPE and MPE. Fourteen pleural effusion biomarkers were compared in 22 MPE patients and five TPE patients. Of the innate immunity biomarkers, the median levels of interleukin (IL)-1β and interferon-induced protein-10 (IP-10) were higher in TPE patients than in MPE patients (P<0.05 and P<0.01, respectively). Of the adaptive immunity biomarkers, the median levels of IL-13 and interferon-γ (IFN-γ) were higher in TPE patients than in MPE patients (P<0.05). In addition, the levels of basic fibroblast growth factor were higher in MPE patients than in TPE patients (P<0.05). Receiver operator characteristic analysis of these biomarkers was performed, resulting in the highest area under the curve (AUC) for IP-10 (AUC =0.95, 95% confidence interval, P<0.01), followed by IL-13 (AUC =0.86, 95% confidence interval, P<0.05). Our study shows that five biomarkers (IL-1β, IP-10, IFN-γ, IL-13, and basic fibroblast growth factor) have a potential diagnostic role in differentiating TPE from MPE, particularly in lung cancer-related MPE. PMID:27354819

  4. ALK positivity on pleuroscopic pleural biopsy in lung adenocarcinoma.

    PubMed

    Vaidya, Preyas J; Kate, Arvind H; Mehta, Deval; Dhabar, Boman N; Chhajed, Prashant N

    2016-01-01

    Lung cancer is the leading cause of cancer deaths worldwide, and around 75% to 80% of lung cancers are detected in advanced stage. Multiple genetic mutations are identified and reported in adenocarcinoma of the lung. Various pulmonary samples can be tested for molecular mutations in lung cancer. However, feasibility of molecular profiling of pleuroscopic pleural biopsies in lung adenocarcinoma is not reported. We describe a case of advanced adenocarcinoma of lung with positive anaplastic lymphoma tyrosine kinase mutation on pleuroscopic pleural biopsy and improved with oral crizotinib. The current case highlights the feasibility of pleuroscopy.-guided pleural biopsies in molecular profiling of lung adenocarcinoma. PMID:27461706

  5. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

    PubMed Central

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal. PMID:27630781

  6. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

    PubMed Central

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal.

  7. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion.

    PubMed

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida; Al-Ourani, Mohammed

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal. PMID:27630781

  8. Malignant pleural mesothelioma: a survival study.

    PubMed

    Harvey, J C; Fleischman, E H; Kagan, A R; Streeter, O E

    1990-09-01

    Ninety-four patients with malignant pleural mesothelioma were treated at Southern California Permanente Medical Group Facilities between 1965 and 1988. This retrospective analysis of survival in these patients is compared according to surgical and/or supportive management. Group I patients received supportive care only, including pleurodesis as needed. This group included the majority of patients. Group II patients were managed largely with debulking procedures including decortication and pleurectomy. Group III patients received extrapleural pneumonectomy. This group included the two long-term survivors of the entire group. This study of survival points out the need for a cooperative protocol as well as the consistent use of proper modern preoperative staging in an attempt to select patients who benefit from extrapleural pneumonectomy.

  9. Malignant pleural effusion and algorithm management

    PubMed Central

    Zarogoulidis, Konstantinos; Darwiche, Kaid; Tsakiridis, Kosmas; Machairiotis, Nikolaos; Kougioumtzi, Ioanna; Courcoutsakis, Nikolaos; Terzi, Eirini; Zaric, Bojan; Huang, Haidong; Freitag, Lutz; Spyratos, Dionysios

    2013-01-01

    Involvement of the pleura in lung cancer is a common manifestation accompanying with reduced life expectancy. Symptoms relief and improvement of the quality of life are the primary goals of the management of malignant pleural effusion (MPE). Histological confirmation is essential for optimal patient management. Lung cancer patients, with life expectancy more than 3 months, resistant to chemotherapy should be treated with thoracentesis, intercoastal tube drainage and installation of a sclerosant agent or pleurodesis through thoracospopic procedures or placement of an indwelling pleura catheter. Talc pleurodesis (sterile asbestos-free graded, particle size >15 μm), as “poudrage” or “slurry” still remains the treatment of choice in patients with MPE resistant to chemotherapy. PMID:24102015

  10. Friction and morphology of pleural mesothelia.

    PubMed

    Pecchiari, Matteo; Sartori, Patrizia; Conte, Vincenzo; D'Angelo, Edgardo; Moscheni, Claudia

    2016-01-01

    To verify the hypothesis that by enmeshing lubricants, microvilli reduce the coefficient of kinetic friction (μ) of pleural mesothelium, μ was measured during reciprocating sliding of rabbit's visceral against parietal pleura before and after addition of hyaluronan, and related to the morphological features of the microvillar network. Because no relation was found between μ or μ changes after hyaluronan and microvillar characteristics, the latter are not determinants of the frictional forces which oppose sliding of normal mesothelial surfaces under physiological conditions, nor of the effects of hyaluronan. Addition of hyaluronan increased μ slightly but significantly in normal specimens, probably by altering the physiological mix of lubricants, but decreased μ of damaged mesothelia, suggesting protective, anti-abrasion properties. Indeed, while sliding of an injured against a normal pleura heavily damaged the latter and increased μ when Ringer was interposed between the surfaces, both effects were limited or prevented when hyaluronan was interposed between the injured and normal pleura before onset of sliding.

  11. Malignant pleural effusion: from bench to bedside.

    PubMed

    Psallidas, Ioannis; Kalomenidis, Ioannis; Porcel, Jose M; Robinson, Bruce W; Stathopoulos, Georgios T

    2016-06-01

    Malignant pleural effusion (MPE) is a common but serious condition that is related with poor quality of life, morbidity and mortality. Its incidence and associated healthcare costs are rising and its management remains palliative, with median survival ranging from 3 to 12 months. During the last decade there has been significant progress in unravelling the pathophysiology of MPE, as well as its diagnostics, imaging, and management. Nowadays, formerly bed-ridden patients are genotyped, phenotyped, and treated on an ambulatory basis. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside. In addition, it highlights unanswered questions in current clinical practice and suggests future directions for basic and clinical research in the field. PMID:27246596

  12. The treatment of recurrent malignant pleural effusion.

    PubMed

    Austin, E H; Flye, M W

    1979-08-01

    Effective control of a recurrent malignant pleural effusion can greatly improve the quality of life of the cancer patient. At least a dozen different techniques have been advocated for controlling this common complication of malignant disease. The present review collects and examines the clinical results of all techniques designed to treat this problem. The pathophysiology and diagnostic evaluation of the effusion are also discussed. On the basis of comparisons involving effectiveness, morbidity, and convenience, we recommend intrapleurally administered tetracycline with thoracostomy drainage as the technique of choice. Instillation of a talc suspension with thoracostomy drainage is also a safe and effective technique and should be employed when tetracycline fails or is contraindicated. PMID:383031

  13. Effect of ventilation frequency and tidal volume on pleural space thickness in rabbits.

    PubMed

    Wang, P M; Lai-Fook, S J

    1993-10-01

    The thickness of the pleural space was measured by fluorescence video-microscopy during mechanical ventilation in anesthetized paralyzed rabbits. A transparent parietal pleural window was made in the fourth or sixth intercostal space near midchest by dissection of intercostal muscle and endothoracic fascia. Fluorescence-labeled (fluorescein isothiocyanate) dextran solution (1 ml) was injected into the pleural space via a rib capsule and allowed to mix with the pleural liquid. With the rabbit in the left lateral decubitus position and the pleural window superior, the light emitted from the pleural liquid through the pleural window was measured through the videomicroscope. Both ventilation frequency and tidal volume were varied. Pleural space thickness was determined by in vitro calibration of the pleural liquid at the end of the experiment. At a frequency of 40 breaths/min and a tidal volume of 20 ml, pleural space thickness averaged 35 +/- 15 (SD) microns (n = 7). When frequency was reduced to 8 breaths/min, this value was reduced by 40% to 22 +/- 11 microns. A reduction in tidal volume from 20 to 6 ml at a frequency of 40 breaths/min produced a similar reduction in pleural space thickness. During apnea, pleural space thickness averaged 11 +/- 3 microns. Cardiogenic motion had no measurable effect on pleural space thickness. The increased pleural space thickness with ventilation might serve to reduce the power dissipated due to sliding of the lung relative to the chest wall. Results support the concept of lubrication as the primary function of the pleural space.

  14. Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study.

    PubMed

    Trásy, Domonkos; Tánczos, Krisztián; Németh, Márton; Hankovszky, Péter; Lovas, András; Mikor, András; Hajdú, Edit; Osztroluczki, Angelika; Fazakas, János; Molnár, Zsolt

    2016-01-01

    Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t 0) and data were also available from the previous day (t -1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t -1: I-group (median [interquartile range]): 1.04 [0.40-3.57] versus NI-group: 0.53 [0.16-1.68], p = 0.444. By t 0 PCT levels were significantly higher in the I-group: 4.62 [1.91-12.62] versus 1.12 [0.30-1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52-0.76], p = 0.022; for percentage change: 0.77 [0.66-0.87], p < 0.001; and for delta-PCT: 0.85 [0.78-0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70-88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816. PMID:27597981

  15. Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

    PubMed Central

    Hankovszky, Péter; Hajdú, Edit

    2016-01-01

    Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t0) and data were also available from the previous day (t−1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t−1: I-group (median [interquartile range]): 1.04 [0.40–3.57] versus NI-group: 0.53 [0.16–1.68], p = 0.444. By t0 PCT levels were significantly higher in the I-group: 4.62 [1.91–12.62] versus 1.12 [0.30–1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52–0.76], p = 0.022; for percentage change: 0.77 [0.66–0.87], p < 0.001; and for delta-PCT: 0.85 [0.78–0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70–88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816. PMID:27597981

  16. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature.

    PubMed

    Mann, Elizabeth A; Wood, Geri L; Wade, Charles E

    2011-06-01

    The purpose of this systematic review was to assess the evidence for use of routine procalcitonin testing to diagnose the presence of sepsis in the burn patient. The electronic databases MEDLINE, Cochrane, CINAHL, ProQuest, and SCOPUS were searched for relevant studies using the MeSH terms burn, infection, procalcitonin, and meta-analysis. The focus of the review was the adult burn population, but other relevant studies of critically ill patients were included as data specific to the patient with burns are limited. Studies were compiled in tabular form and critically appraised for quality and level of evidence. Four meta-analyses, one review of the literature, one randomized controlled trial, nine prospective observational, and three retrospective studies were retrieved. Six of these studies were specific to the burn population, with one specific to burned children. Only one meta-analysis, one adult burn and one pediatric burn study reported no benefit of procalcitonin testing to improve diagnosis of sepsis or differentiate sepsis from non-infectious systemic inflammatory response. The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination. Evaluation of the burn specific studies is limited by the use of guidelines to define sepsis and inconsistent results from the burn studies. Utility of the procalcitonin assay is limited due to the lack of availability of rapid, inexpensive tests. However, it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit.

  17. Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

    PubMed Central

    Falsey, Ann R; Becker, Kenneth L; Swinburne, Andrew J; Nylen, Eric S; Snider, Richard H; Formica, Maria A; Hennessey, Patricia A; Criddle, Mary M; Peterson, Derick R; Walsh, Edward E

    2012-01-01

    Background Serum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia. Methods Adults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared. Results In total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor. Conclusion Procalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD. PMID:22399852

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

    PubMed

    Xu, L; Wang, P; Chen, S

    1994-06-01

    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.

  19. When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters

    PubMed Central

    Sandri, Alberto; Guerrera, Francesco; Ferraris, Andrea; Marchisio, Filippo; Bora, Giulia; Costardi, Lorena; Solidoro, Paolo; Ruffini, Enrico; Oliaro, Alberto

    2016-01-01

    Tube thoracostomy is usually the first step to treat several thoracic/pleural conditions such as pneumothorax, pleural effusions, haemothorax, haemo-pneumothorax and empyema. Today, a wide range of drains is available, ranging from small to large bore ones. Indications for an appropriate selection remains yet matter of debate, especially regarding the use of small bore catheters. Through this paper, we aimed to retrace the improvements of drains through the years and to review the current clinical indications for chest drain placement in pleural/thoracic diseases, comparing the effectiveness of small-bore drains vs. large-bore ones. PMID:27499983

  20. When size matters: changing opinion in the management of pleural space-the rise of small-bore pleural catheters.

    PubMed

    Filosso, Pier Luigi; Sandri, Alberto; Guerrera, Francesco; Ferraris, Andrea; Marchisio, Filippo; Bora, Giulia; Costardi, Lorena; Solidoro, Paolo; Ruffini, Enrico; Oliaro, Alberto

    2016-07-01

    Tube thoracostomy is usually the first step to treat several thoracic/pleural conditions such as pneumothorax, pleural effusions, haemothorax, haemo-pneumothorax and empyema. Today, a wide range of drains is available, ranging from small to large bore ones. Indications for an appropriate selection remains yet matter of debate, especially regarding the use of small bore catheters. Through this paper, we aimed to retrace the improvements of drains through the years and to review the current clinical indications for chest drain placement in pleural/thoracic diseases, comparing the effectiveness of small-bore drains vs. large-bore ones. PMID:27499983

  1. Erythrocytosis and pleural effusion associated with a hepatoblastoma in a Thoroughbred yearling.

    PubMed

    Axon, J E; Russell, C M; Begg, A P; Adkins, A R

    2008-08-01

    A 10-month-old Thoroughbred filly was presented with a 2-month history of recurrent fever and pleural effusion. Major clinical findings were pyrexia and congested mucous membranes. Clinical pathology tests revealed an erythrocytosis, hyperfibrinogenaemia and hyperglobulinaemia. Pleural fluid was seen on ultrasonographic examination of the thorax and analysis of a thoracocentesis sample indicated a lymphocytic, modified transudate. A transtracheal aspirate was normal. The erythrocytosis persisted despite IV fluid therapy. Arterial blood gas analysis and bone marrow aspirate were normal. These findings were indicative of secondary inappropriate erythrocytosis. Ultrasonographic examination of the abdomen showed a large encapsulated heterogeneous mass in the left lobe of the liver. Histopathological evaluation of a biopsy of the mass was indicative of a hepatic carcinoma. The filly was euthanased and necropsy confirmed the presence of a hepatic tumour with no evidence of systemic metastasis. Further histopathological evaluation confirmed the tumour to be an embryonal macrotrabecular epithelial-type hepatoblastoma, a type of hepatoblastoma that has not previously been reported in a horse. PMID:18673477

  2. Accuracy of death certification of pleural mesothelioma in Italy.

    PubMed

    Bruno, C; Comba, P; Maiozzi, P; Vetrugno, T

    1996-08-01

    In order to provide estimates of the accuracy of death certification of malignant pleural mesothelioma in Italy, the causes of death of a series of ascertained cases were investigated. The study included 523 cases of pleural mesothelioma diagnosed in 1984-1988 by 88 hospital departments and clinics. Vital status at 7 May 1990 was ascertained for 92.7% of subjects. The overall concordance between pathological diagnosis and death certification was about 75%.

  3. [POSSIBILITIES OF MODERN TECHNOLOGIES IN THE TREATMENT OF PLEURAL EMPYEMA].

    PubMed

    Tronina, E Yu; Shipulin, P P; Baydan, V I; Severgin, V E; Baydan, V V; Ageyev, S V; Kirilyuk, A A; Kozyar, O N; Polyak, S D; Agrakhari, A

    2016-03-01

    The data, concerning videothoracoscopic operations application in the acute pleural empyema treatment in 462 patients, were adduced. Efficacy of videothoracoscopic operations, using electrowelding and radiofrequency surgical complexes with possibility to eliminate pulmonary-pleural fistulas, was shown. Positive clinical effect was noted in 443 (95.9%) patients, duration of stationary treatment have constituted 11.1 days at average. The complications have had occurred in 19 (4.1%) patients. All the patients are alive. PMID:27514094

  4. Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters

    PubMed Central

    Azzopardi, Maree; Thomas, Rajesh; Muruganandan, Sanjeevan; Lam, David C L; Garske, Luke A; Kwan, Benjamin C H; Rashid Ali, Muhammad Redzwan S; Nguyen, Phan T; Yap, Elaine; Horwood, Fiona C; Ritchie, Alexander J; Bint, Michael; Tobin, Claire L; Shrestha, Ranjan; Piccolo, Francesco; De Chaneet, Christian C; Creaney, Jenette; Newton, Robert U; Hendrie, Delia; Murray, Kevin; Read, Catherine A; Feller-Kopman, David; Maskell, Nick A; Lee, Y C Gary

    2016-01-01

    Introduction Malignant pleural effusions (MPEs) can complicate most cancers, causing dyspnoea and impairing quality of life (QoL). Indwelling pleural catheters (IPCs) are a novel management approach allowing ambulatory fluid drainage and are increasingly used as an alternative to pleurodesis. IPC drainage approaches vary greatly between centres. Some advocate aggressive (usually daily) removal of fluid to provide best symptom control and chance of spontaneous pleurodesis. Daily drainages however demand considerably more resources and may increase risks of complications. Others believe that MPE care is palliative and drainage should be performed only when patients become symptomatic (often weekly to monthly). Identifying the best drainage approach will optimise patient care and healthcare resource utilisation. Methods and analysis A multicentre, open-label randomised trial. Patients with MPE will be randomised 1:1 to daily or symptom-guided drainage regimes after IPC insertion. Patient allocation to groups will be stratified for the cancer type (mesothelioma vs others), performance status (Eastern Cooperative Oncology Group status 0–1 vs ≥2), presence of trapped lung (vs not) and prior pleurodesis (vs not). The primary outcome is the mean daily dyspnoea score, measured by a 100 mm visual analogue scale (VAS) over the first 60 days. Secondary outcomes include benefits on physical activity levels, rate of spontaneous pleurodesis, complications, hospital admission days, healthcare costs and QoL measures. Enrolment of 86 participants will detect a mean difference of VAS score of 14 mm between the treatment arms (5% significance, 90% power) assuming a common between-group SD of 18.9 mm and a 10% lost to follow-up rate. Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study (number 2015-043). Results will be published in peer-reviewed journals and presented at scientific meetings. Trial registration

  5. PDT Dose Dosimeter for Pleural Photodynamic Therapy

    PubMed Central

    Kim, Michele M.; Darafsheh, Arash; Ahmad, Mahmoud; Finlay, Jarod C.; Zhu, Timothy C.

    2016-01-01

    PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT), a PDT dose dosimeter was developed to measure both the light fluence and the photosensitizer concentration simultaneously in the same treatment location. Light fluence and spectral data were rigorously compared to other methods of measurement (e.g. photodiode, multi-fiber spectroscopy contact probe) to assess the accuracy of the measurements as well as their uncertainty. Photosensitizer concentration was obtained by measuring the fluorescence of the sensitizer excited by the treatment light. Fluence rate based on the intensity of the laser spectrum was compared to the data obtained by direct measurement of fluence rate by a fiber-coupled photodiode. Phantom studies were done to obtain an optical property correction for the fluorescence signal. Measurements were performed in patients treated Photofrin for different locations in the pleural cavity. Multiple sites were measured to investigate the heterogeneity of the cavity and to provide cross-validation via relative dosimetry. This novel method will allow for accurate real-time determination of delivered PDT dose and improved PDT dosimetry. PMID:27053825

  6. PDT dose dosimeter for pleural photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Kim, Michele M.; Darafsheh, Arash; Ahmad, Mahmoud; Finlay, Jarod C.; Zhu, Timothy C.

    2016-03-01

    PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT), a PDT dose dosimeter was developed to measure both the light fluence and the photosensitizer concentration simultaneously in the same treatment location. Light fluence and spectral data were rigorously compared to other methods of measurement (e.g. photodiode, multi-fiber spectroscopy contact probe) to assess the accuracy of the measurements as well as their uncertainty. Photosensitizer concentration was obtained by measuring the fluorescence of the sensitizer excited by the treatment light. Fluence rate based on the intensity of the laser spectrum was compared to the data obtained by direct measurement of fluence rate by a fiber-coupled photodiode. Phantom studies were done to obtain an optical property correction for the fluorescence signal. Measurements were performed in patients treated Photofrin for different locations in the pleural cavity. Multiple sites were measured to investigate the heterogeneity of the cavity and to provide cross-validation via relative dosimetry. This novel method will allow for accurate real-time determination of delivered PDT dose and improved PDT dosimetry.

  7. The Importance of Serum Procalcitonin in Diagnosis and Treatment of Serious Bacterial Infections and Sepsis

    PubMed Central

    Mehanic, Snjezana; Baljic, Rusmir

    2013-01-01

    The clinical utility of serum procalcitonin (PCT) levels continues to evolve. PCT is regarded as a promising candidate marker for making a diagnosis and antibiotic stewardship in patients with systemic infections. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker when used with validated diagnostic algorithms. PMID:24511275

  8. Sensitivity and Specificity of Procalcitonin to Determine Etiology of Diarrhea in Children Younger Than 5 Years

    PubMed Central

    Ismaili-Jaha, Vlora; Shala, Mujë; Azemi, Mehmedali; Spahiu, Shqipe; Hoxha, Teuta; Avdiu, Muharrem; Spahiu, Lidvana

    2014-01-01

    Aim: The aim of this study is to assess the sensitivity and specificity of procalcitonin to determine bacterial etiology of diarrhea. The examinees and methods: For this purpose we conducted the study comprising 115 children aged 1 to 60 months admitted at the Department of Pediatric Gastroenterology, Pediatric Clinic, divided in three groups based on etiology of the diarrhea that has been confirmed with respective tests during the hospitalization. Each group has equal number of patients – 35. The first group was confirmed to have bacterial diarrhea, the second viral diarrhea and the third extra intestinal diarrhea. The determination of procalcitonin has been established with the ELFA methods of producer B.R.A.H.M.S Diagnostica GmbH, Berlin, (Germany). Results: From the total number of 1130 patient with acute diarrhea procalcitonin was assessed in 105. 67 (63.8%) of these patient were male. More than one third (38.14%) of the children in our study were younger then 12 months. Approximately the same was the number of children 13-24 months (33 patients or 31.43%) and 25-60 months (32 patients or 30.43%). The mean value of PRC in children with viral diarrhea was 0.13±0.5 ng/mL in children with bacterial diarrhea was 5.3±4.9 ng/m Land in children with extra intestinal diarrhea was 1.7±2.8 ng/mL. When measured using ANOVA and Turkey HSD tests, results have shown the statistical significance when comparing viral with bacterial and extra intestinal diarrhea but were statistically insignificant when comparing bacterial and extra intestinal diarrhea. Conclusion: Procalcitonin is an important but not conclusive marker of bacterial etiology of acute diarrhea in children younger than 5 years. PMID:24944526

  9. Computed tomographic findings of environmental asbestos-related malignant pleural mesothelioma.

    PubMed

    Yilmaz, U M; Utkaner, G; Yalniz, E; Kumcuoglu, Z

    1998-03-01

    Malignant pleural mesothelioma (MPM) is not an infrequent fatal neoplasm. It is endemically present in some regions of Turkey due to its aetiological relationship to exposure to environmental fibrous minerals. The aim of this study was to determine the thorax computed tomographic (CT) features of environmental asbestos-related MPM. In this study, we examined retrospectively the CT scans of 46 untreated patients with pathological diagnosis of environmental asbestos-related MPM among 151 patients with malignant pleural mesothelioma in the Izmir Chest Disease and Surgery Hospital. The CT scans were interpreted by consultation of four observers. Malignant pleural mesothelioma was unilateral in 45 (97.2%) of the patients. Pleural effusions were found in 42 (91%) of the patients, pleural calcifications in 12 (26%), contracted hemithorax in 14 (30%), interlobar fissure involvement in 25 (54%) and mediastinal pleural involvement in 26 (57%). A contracted hemithorax was significantly correlated with pleural rind configuration. Pleural thickenings were found in 45 (99%) of the patients. Pleural thickenings were in the form of nodularity in 10 (22%) cases, regular in 12 (27%) cases, as a focal mass in 3 (7%) cases and as a pleural rind in 20 (44%) cases. Pleural thickening was greater than 1 cm in 32 (71%) cases. The most common CT findings in our series were unilateral circumferential pleural thickening, nodular pleural thickening, pleural thickening greater than 1 cm and mediastinal pleural involvement. Generally, pleural effusion was accompanied by this. There was interlobar fissure involvement in half of the patients. There was no pathognomonic CT finding in environmental asbestos-related MPM. But CT was useful in suggesting the diagnosis of malignant pleural disease in the cases with MPM.

  10. Efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions.

    PubMed Central

    Villanueva, A. G.; Gray, A. W.; Shahian, D. M.; Williamson, W. A.; Beamis, J. F.

    1994-01-01

    BACKGROUND--A study was undertaken to compare the efficacy of short term tube thoracostomy drainage with standard tube thoracostomy drainage before instillation of tetracycline for sclerotherapy of malignant pleural effusions. METHODS--The study consisted of a randomised clinical trial in a sequential sample of 25 patients with malignant pleural effusions documented cytopathologically. Fifteen patients were randomly assigned to group 1 (standard protocol) and 10 to group 2 (short term protocol). Patients in group 1 had tube thoracostomy suction drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was < 150 ml/day, before tetracycline (1.5 g) was instilled. The chest tube was removed when the amount of fluid drained after instillation was < 150 ml/day. Patients in group 2 also had suction drainage, but the tetracycline (1.5 g) was instilled when the chest radiograph showed the lung to be re-expanded and the effusion drained, which was usually within 24 hours. The chest tube was removed the next day. RESULTS--The response to tetracycline sclerotherapy in the two groups was the same (80%) but the duration of chest tube drainage was significantly shorter for patients in group 2 (median two days) than for those in group 1 (median seven days). CONCLUSIONS--The duration of chest tube drainage before sclerotherapy for malignant pleural effusions need not be influenced by the amount of fluid drained daily but by radiographic evidence of fluid evacuation and lung re-expansion. Shorter duration of drainage will reduce the length of hospital stay without sacrificing the efficacy of pleurodesis. PMID:7512285

  11. Proteomic characterization of pleural effusion, a specific host niche of Mycoplasma mycoides subsp. mycoides from cattle with contagious bovine pleuropneumonia (CBPP).

    PubMed

    Weldearegay, Yenehiwot B; Pich, Andreas; Schieck, Elise; Liljander, Anne; Gicheru, Nimmo; Wesonga, Hezron; Thiaucourt, Francois; Kiirika, Leonard M; Valentin-Weigand, Peter; Jores, Joerg; Meens, Jochen

    2016-01-10

    Mycoplasma mycoides subsp. mycoides (Mmm) is the causative agent of contagious bovine pleuropneumonia (CBPP), a severe pleuropneumonia in cattle. The abnormal accumulation of pleural fluid, called pleural effusion (PE), is one of the characteristics of this disease. We performed a proteomic analysis of seven PE samples from experimentally infected cattle and characterized their composition with respect to bovine and Mmm proteins. We detected a total of 963 different bovine proteins. Further analysis indicated a strong enrichment of proteins involved in antigen processing, platelet activation and degranulation and apoptosis and an increased abundance of acute phase proteins.With regard to the pathogen, up to 108 viable mycoplasma cells per ml were detected in the PE supernatant. The proteomic analysis revealed 350 mycoplasma proteins, including proteins involved in virulence-associated processes like hydrogen peroxide (H2O2) production and capsule synthesis. The bovine proteins detected will aid to characterize the inflammasome during an acute pleuropneumonia in cattle and the identified mycoplasma proteins will serve as baseline data to be compared with in vitro studies to improve our understanding of pathogenicity mechanisms. Based on our results, we named the pleural effusion an “in vivo niche” of Mmm during the acute phase of CBPP. Biological significance: This is the first study on bovine pleural effusions derived from an infectious disease and the first approach to characterize the proteome of Mycoplasma mycoides in vivo. This study revealed a high number of viable Mmm cells in the pleural effusion. The bovine pleural effusion proteome during Mmm infection is qualitatively similar to plasma, but differs with respect to high abundance of acute phase proteins. On the other hand,Mmm in its natural host produces proteins involved in capsule synthesis, H2O2 production and induction of inflammatory response, supporting previous knowledge on mechanisms underlying

  12. Proteomic characterization of pleural effusion, a specific host niche of Mycoplasma mycoides subsp. mycoides from cattle with contagious bovine pleuropneumonia (CBPP).

    PubMed

    Weldearegay, Yenehiwot B; Pich, Andreas; Schieck, Elise; Liljander, Anne; Gicheru, Nimmo; Wesonga, Hezron; Thiaucourt, Francois; Kiirika, Leonard M; Valentin-Weigand, Peter; Jores, Joerg; Meens, Jochen

    2016-01-10

    Mycoplasma mycoides subsp. mycoides (Mmm) is the causative agent of contagious bovine pleuropneumonia (CBPP), a severe pleuropneumonia in cattle. The abnormal accumulation of pleural fluid, called pleural effusion (PE), is one of the characteristics of this disease. We performed a proteomic analysis of seven PE samples from experimentally infected cattle and characterized their composition with respect to bovine and Mmm proteins. We detected a total of 963 different bovine proteins. Further analysis indicated a strong enrichment of proteins involved in antigen processing, platelet activation and degranulation and apoptosis and an increased abundance of acute phase proteins.With regard to the pathogen, up to 108 viable mycoplasma cells per ml were detected in the PE supernatant. The proteomic analysis revealed 350 mycoplasma proteins, including proteins involved in virulence-associated processes like hydrogen peroxide (H2O2) production and capsule synthesis. The bovine proteins detected will aid to characterize the inflammasome during an acute pleuropneumonia in cattle and the identified mycoplasma proteins will serve as baseline data to be compared with in vitro studies to improve our understanding of pathogenicity mechanisms. Based on our results, we named the pleural effusion an “in vivo niche” of Mmm during the acute phase of CBPP. Biological significance: This is the first study on bovine pleural effusions derived from an infectious disease and the first approach to characterize the proteome of Mycoplasma mycoides in vivo. This study revealed a high number of viable Mmm cells in the pleural effusion. The bovine pleural effusion proteome during Mmm infection is qualitatively similar to plasma, but differs with respect to high abundance of acute phase proteins. On the other hand,Mmm in its natural host produces proteins involved in capsule synthesis, H2O2 production and induction of inflammatory response, supporting previous knowledge on mechanisms underlying

  13. Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Pleural Effusion

    PubMed Central

    Kiani, Arda; Karimi, Mahmoud; Samadi, Katayoun; Sheikhy, Kambiz; Farzanegan, Behrooz; Pour Abdollah, Mihan; Jamaati, Hamidreza; Jabardarjani, Hamid Reza; Masjedi, Mohammad Reza

    2015-01-01

    Background: One of the most common indications for pleuroscopy is undiagnosed pleural effusion, which comprises about 25% of all cases of pleural effusions, which remain undiagnosed despite primary tests. Pleuroscopy was performed for the first time in Iran in Masih Daneshvari hospital located in Tehran. The aim of this study was to assess the diagnostic yield of pleuroscopy performed in this center in Iran. Materials and Methods: Three-hundred patients with undiagnosed pleural effusions were enrolled in this study. For all patients, primary tests including pleural effusion analysis, cytology and closed pleural biopsy (if needed) were conducted and all of them were inconclusive. The semirigid thoracoscopy (pleuroscopy) was performed for all patients for diagnostic purposes. Results: Eighty-seven percent of the peluroscopies were diagnostic and 67% of them were diagnosed as malignancy while the rest were diagnosed as tuberculosis. Only 11 patients developed minor complications. Conclusion: In conclusion, pleuroscopy is a safe procedure when performed by a skilled and experienced practitioner; it has a high diagnostic yield and results in only minor complications. PMID:27114723

  14. The posterior pleural junction line in pneumoconiosis. A report of 3 cases with thickening.

    PubMed

    Thomas, R G; Sluis-Cremer, G K; Solomon, A

    1987-06-20

    Disease may change the position or cause thickening or distortion of the posterior pleural junction line. Pleural changes associated with silica or asbestos exposure may also result in radiologically recognisable thickening of the line. Three examples are presented. PMID:3603276

  15. Emergency operation of a patient with spontaneous rupture and massive hemorrhage of pleural solitary fibrous tumor.

    PubMed

    Shao, Feng; Yang, Rusong; Pan, Yanqing

    2014-10-01

    Solitary fibrous tumor (SFT) is a rare pleural disease with asymptomatic clinical course. We report a case of a patient with spontaneous rupture and massive hemorrhage of pleural SFT, which was treated by emergency operation.

  16. Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous.

    PubMed

    Ocampo, Vanessa; Haaland, Derek; Legault, K; Mittoo, Shika; Aitken, Emily

    2016-01-01

    A 22-year-old Caucasian man presented to hospital with pleuritic chest pain. He had had a history of a sun-sensitive rash a year prior. Workup revealed normal cardiac enzymes and chest X-ray. However, electrocardiogram revealed ST elevation and PR depression, and echocardiogram revealed a slight pericardial effusion without other findings. A diagnosis of pericarditis was made. Subsequently, he was found to be positive for antinuclear antibodies (ANAs), as well as antibodies to SSA, SSB and double-stranded DNA; C3 was low, and C4 was undetectable. A diagnosis of systemic lupus erythematosus was made. The patient initially responded to high-dose ibuprofen. One month later, he developed a new pericardial effusion, this time with concomitant massive left-sided pleural effusion, requiring three separate thoracenteses draining a total of 6 L of pleural fluid. The recurrent effusion failed to respond to high-dose corticosteroid treatment. Owing to the severity and rapidity of the recurrence of pleural and pericardial effusion, intravenous tocilizumab was administered. The patient had excellent clinical and radiographic improvement. This case shows that tocilizumab may have a role in the treatment of intractable pleuropericardial effusion and other forms of lupus-associated serositis. PMID:27503940

  17. Occupational risks for pleural mesothelioma in Sweden, 1961-79.

    PubMed

    Malker, H S; McLaughlin, J K; Malker, B K; Stone, B J; Weiner, J A; Erickson, J L; Blot, W J

    1985-01-01

    From national population-based registries linking cancer incidence from 1961 to 1979 with 1960 census data on industry and occupation for all employed individuals in Sweden, a systematic assessment was made of pleural mesothelioma occurrence according to occupational and industrial classifications. There were 318 cases of pleural mesothelioma recorded during the 19-year follow-up period among males employed in 1960, with significant variation by industrial and occupational categorizations. The observed number of pleural mesotheliomas for men employed in the sugar refining, cellulose, wood and pulp, shipbuilding, and railroad equipment manufacturing industries was more than three times the number expected. Occupations with at least twofold excess of mesotheliomas included the craftsman categories of plumbers, mechanics and repairmen, electricians, painters, tire makers, and stationary equipment operators. Our findings are consistent with available data relating mesothelioma to occupational asbestos exposure in other countries, although unexpected associations were found that deserve further epidemiologic study.

  18. Primary pleural mesotheliomas in south India: a 25-year study.

    PubMed

    Kini, U; Shariff, S; Thomas, J A

    1992-03-01

    In this report from South India, 15 patients with primary pleural mesothelioma have been diagnosed in the 25-year period 1, April 1966 through 31, March 1991, representing 0.02% of 76,239 biopsies received. The patients were mainly male with a mean age of 46.5 years. All except two had lived in urban Bangalore. None had been exposed to asbestos. The presentation clinically was peculiar, being continuous pricking pain, breathlessness, and cough with sputum. Physical and roentgenogram examination showed massive pleural effusion with irregular pleural thickening. Thoracotomy findings showed a distinct sessile nodularity with many slit-like spaces. Histologically, 14 were epithelial type mesotheliomas and 1 was a sarcomatous type. While the epithelial type neoplasms showed patchy squamoid differentiation, all showed mucin production. The CEA was always observed in areas of moderate differentiation. Spread occurred centrifugally to local structures on the same side as the lesion.

  19. [Surgical treatment of lung cancer complicated by pleural effusion].

    PubMed

    Iaitskiĭ, N A; Akopov, A L; Egorov, V I; Deĭneka, I V; Chistiakov, I V

    2012-01-01

    The authors made a retrospective analysis of 51 patients with non-small-cell lung cancer with pleural effusion, not associated with tumor lesion of pleural leaves. Out of 51 operated patients 45 (88%) proved to be resectable. Among 45 patients (20 pneumonectomies, 24 lobectomies and 1 bilobectomy) combined interventions were fulfilled in 15 patients. In 27 (60%) out of 45 patients there was an injury of mediastinal lymph nodes, in 13 (29%)--intrapulmonary and root nodes. Complicated course of the postoperative period was noted in 27% of patients, lethality was 2%. One year survival after resection was 86%, three and five year survival was 54% and 30% respectively. The indices of survival reliably depended on the degree of lymphogenic dissemination. The presence of pleural effusion can not be a reason for refusal to fulfill radical surgical intervention. PMID:23488256

  20. [Mediastinitis and bilateral pleural effusion of pancreatic origin (author's transl)].

    PubMed

    Holzer, R; Pesendorfer, F X; Pridun, N

    1982-01-01

    A case report is presented of a patient admitted to a thoracic specialist unit on account of predominantly pulmonary symptomatology. There was a left-sided haemorrhagic pulmonary effusion, which rapidly returned after tapping. The patient then developed a high fever and shock. Mediastinal widening was noted on X-ray, as well as a right-sided pleural effusion. Repeated tapping of the pleural effusions and drainage of a mediastinal abscess, which was diagnosed on mediastinoscopy as well as the administration of antibiotics led to an improvement in the patient's previously poor general condition. Sonography and subsequent endoscopic retrograde pancreatography were instrumental in eventually diagnosing chronic recurrent pancreatitis with cyst formation and retroperitoneal perforation into the mediastinum and pleural space. Laparotomy with removal of the pancreatic cysts and abdominal drainage led to complete recovery. The pathogenetic processes involved in the formation of internal fistulae, diagnostic problems and therapeutic management are discussed.

  1. Eosinophilic pleural effusion due to Spirometra mansoni spargana: a case report and review of the literature.

    PubMed

    Lin, Quan; Ouyang, Jin-Sheng; Li, Jian-Min; Yang, Li; Li, Yu-Ping; Chen, Cheng-Shui

    2015-05-01

    A 36-year-old female presented with an eosinophilic pleural effusion. The eosinophilic pleural effusion was considered to have been caused by a parasitic infection. Spirometra mansoni spargana was confirmed by semi-rigid thoracoscopy. About 2 months after treatment with praziquantel for 3 days, the pleural effusion had disappeared on the chest roentgenogram.

  2. Pleural effusion as a manifestation of multiple myeloma.

    PubMed

    Iqbal, Nousheen; Tariq, Muhammad Usman; Shaikh, Mohammad Usman; Majid, Hashir

    2016-01-01

    Multiple myeloma is a clonal B-cell malignancy, characterised by proliferation of plasma cells and secretion of paraproteins. These plasma cells accumulate predominantly in the bone marrow; rarely, they invade other areas, especially the thorax. Myeloma presenting with a pleural effusion is rare and reported in only 6% of patients with myeloma. Such patients generally present late and have a poor prognosis. Here, we describe a patient presenting with a lung mass, renal failure and a massive unilateral pleural effusion due to multiple myeloma who was treated successfully. PMID:27520995

  3. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

    PubMed Central

    Diacovo, Maria Julia

    2016-01-01

    Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma. PMID:27660729

  4. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

    PubMed Central

    Diacovo, Maria Julia

    2016-01-01

    Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma.

  5. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor.

    PubMed

    Gleason, James Benjamin; Tashtoush, Basheer; Diacovo, Maria Julia

    2016-01-01

    Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma. PMID:27660729

  6. Malignant Pleural Effusion: Medical Approaches for Diagnosis and Management

    PubMed Central

    2014-01-01

    Malignant pleural effusions (MPEs) are the second leading cause of exudative pleural effusions after parapneumonic effusions. In the vast majority of cases, a MPE signifies incurable disease associated with high morbidity and mortality. Considerable advances have been made for the diagnosis of MPEs, through the development of improved methods in the specialized cytological and imaging studies. The cytological or histological confirmation of malignant cells is currently important in establishing a diagnosis. Furthermore, despite major advancements in cancer treatment for the past two decades, management of MPE remains palliative. This article presents a comprehensive review of the medical approaches for diagnosis and management of MPE. PMID:24920947

  7. Quality-Adjusted Survival Following Treatment of Malignant Pleural Effusions With Indwelling Pleural Catheters

    PubMed Central

    Jimenez, Carlos A.; Lei, Xiudong; Cantor, Scott B.; Grosu, Horiana B.; Lazarus, Donald R.; Faiz, Saadia A.; Bashoura, Lara; Shannon, Vickie R.; Balachandran, Dave; Noor, Lailla; Hashmi, Yousra B.; Casal, Roberto F.; Morice, Rodolfo C.; Eapen, George A.

    2014-01-01

    Background: Malignant pleural effusions (MPEs) are a frequent cause of dyspnea in patients with cancer. Although indwelling pleural catheters (IPCs) have been used since 1997, there are no studies of quality-adjusted survival following IPC placement. Methods: With a standardized algorithm, this prospective observational cohort study of patients with MPE treated with IPCs assessed global health-related quality of life using the SF-6D to calculate utilities. Quality-adjusted life days (QALDs) were calculated by integrating utilities over time. Results: A total of 266 patients were enrolled. Median quality-adjusted survival was 95.1 QALDs. Dyspnea improved significantly following IPC placement (P < .001), but utility increased only modestly. Patients who had chemotherapy or radiation after IPC placement (P < .001) and those who were more short of breath at baseline (P = .005) had greater improvements in utility. In a competing risk model, the 1-year cumulative incidence of events was death with IPC in place, 35.7%; IPC removal due to decreased drainage, 51.9%; and IPC removal due to complications, 7.3%. Recurrent MPE requiring repeat intervention occurred in 14% of patients whose IPC was removed. Recurrence was more common when IPC removal was due to complications (P = .04) or malfunction (P < .001) rather than to decreased drainage. Conclusions: IPC placement has significant beneficial effects in selected patient populations. The determinants of quality-adjusted survival in patients with MPE are complex. Although dyspnea is one of them, receiving treatment after IPC placement is also important. Future research should use patient-centered outcomes in addition to time-to-event analysis. Trial registry: ClinicalTrials.gov; No.: NCT01117740; URL: www.clinicaltrials.gov PMID:24480929

  8. Talc pleurodesis through indwelling pleural catheters for malignant pleural effusions: retrospective case series of a novel clinical pathway.

    PubMed

    Ahmed, Liju; Ip, Hugh; Rao, Deepak; Patel, Nishil; Noorzad, Farinaz

    2014-12-01

    Malignant pleural effusions cause significant morbidity, but there is no gold standard minimally invasive treatment. A new therapeutic approach combines talc pleurodesis and indwelling pleural catheters (IPCs) to enable outpatient management. This case series summarizes the safety and efficacy data of all patients (24) with a symptomatic malignant pleural effusion who underwent talc pleurodeses via IPCs between December 2010 and July 2013. Successful pleurodesis was achieved in 22 procedures (92%). There was one empyema, one hydropneumothorax, one recurrent effusion, and two minor complications: one drain site wound infection and one complaint of chest pain. Twenty-two procedures (92%) were performed in the outpatient setting. This report confirms the safety and efficacy of administering talc slurry through IPCs in an outpatient setting. Studies in a larger cohort are necessary to define the role of this novel approach in the treatment algorithm of patients with this condition. PMID:25451360

  9. Primary pleural lymphoma: a rare case and a synopsis of the literature

    PubMed Central

    Ru, Xiaohu; Ge, Mingjian; Li, Li; Lin, Yidan

    2013-01-01

    We report a case of a 74-year-old woman with no history of HIV infection or pyothorax who presented with progressive dyspnoea. Computed tomography (CT) showed bulky pleural mass and pleural effusion associated with the right-sided pleural disease. Thoracoscopic pleural biopsy was performed and revealed the diagnosis of primary pleural malignant lymphoma. Histopathological and immunohistochemical examinations revealed that it was small B-cell lymphoma with neoplastic cells that expressed the CD-20 antigen. This case is thought to be a very rare case of primary malignant lymphoma arising in the pleura of a patient with no history of pyothorax. PMID:23991319

  10. Second line therapy in malignant pleural mesothelioma: A systematic review.

    PubMed

    Buikhuisen, Wieneke A; Hiddinga, Birgitta I; Baas, Paul; van Meerbeeck, Jan P

    2015-09-01

    After the implementation of standard first line chemotherapy with platinum and antifolates in pleural mesothelioma, patients are confronted with a need for second line treatment at relapse or progression. We conducted a systematic review of the literature for the activity, effectiveness and toxicity of second line treatment. The results are presented according to the class of drugs: chemotherapy and targeted or biological agent.

  11. New Tetratrichomonas Species in Two Patients with Pleural Empyema

    PubMed Central

    Lopez-Escamilla, Eduardo; Sanchez-Aguillon, Fabiola; Alatorre-Fernandez, Cynthia Pamela; Aguilar-Zapata, Daniel; Arroyo-Escalante, Sara; Arellano, Teresa; Moncada-Barron, David; Romero-Valdovinos, Mirza; Martinez-Hernandez, Fernando; Rodriguez-Zulueta, Patricia

    2013-01-01

    Two unusual occurrences of pleural trichomonosis due to a new Tetratrichomonas species previously reported but not named were confirmed. In one patient, Trichomonas tenax and a Tetratrichomonas species were also detected in the oral cavity by molecular methods. We suggest that this new Tetratrichomonas species be named Tetratrichomonas empyemagena. PMID:23784131

  12. Effect of positive pleural pressure on left ventricular performance

    SciTech Connect

    Natarajan, T.K.; Karam, M.; Wise, R.; Wagner, H.N.

    1984-01-01

    A sudden increase in pleural pressure such as coughing or a valsalva maneuver causes a transient increase in left ventricular stroke volume but the mechanism is not known. To help understand this phenomenon we studied 7 normal volunteers during spontaneous breathing and when breathing under positive pleural pressure. The positive pressure was developed by expiring against a 24cm H/sub 2/O threshold load. Radionuclide ventriculopgraphy using a double gating technique as performed. Image data were acquired during the cardiac cycles occurring during positive pleural pressure by means of a pressure transducer coupled to an EKG gate. They were compared to data acquired by EKG gating alone under quiet respiration as control. Results are shown for end diastolic (EDC), end systolic (ESC) and stroke counts (SC) and are expressed as % change from control for each parameter. The authors conclude that a transient increase in positive pleural pressure comparable to that reached during forceful coughing increases stroke volume and cardiac output through a combination of increased end diastolic volume with a lesser increase in end systolic volume. This effect was seen in the absence of any change in cardiac rhythm or rate.

  13. Complications of indwelling pleural catheter use and their management

    PubMed Central

    Lui, Macy M S; Thomas, Rajesh; Lee, Y C Gary

    2016-01-01

    The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies. PMID:26870384

  14. Indications of an increase of occupational pleural mesothelioma in Japan.

    PubMed

    Baba, K

    1983-03-01

    In order to obtain an epidemiological picture of occupational pleural malignant mesotheliomas in Japan, the author surveyed the Annual of Pathological Autopsy Cases (published by the Japanese Pathological Society) from 1974 through 1980. Two hundred and twenty-two malignant mesotheliomas (0.114% of all autopsy cases) were found in that period. One hundred and forty-five cases (0.074%) of them were of pleural origin. Until 1977, there were no pleural malignant mesotheliomas associated with asbestosis, but there were one in 1978, three in 1979 and two in 1980. Two of them were housewives and the others were a ship builder, a welder, a ceramist and a steel factory worker. Two lived in Sakae City, and the others in Kure City, Kaizuka City, Nagasaki City and Kanagawa Prefecture, where large shipyards are located. Compared to the Western countries, there is a time lag of 10 to 20 years in the increase of consumption of asbestos in Japan, where the increase has occurred rapidly after World War II. The epidemiological picture obtained by this study clearly states that the number of occupational pleural malignant mesotheliomas began to increase in the past few years in Japan.

  15. Complications of indwelling pleural catheter use and their management.

    PubMed

    Lui, Macy M S; Thomas, Rajesh; Lee, Y C Gary

    2016-01-01

    The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies.

  16. New tetratrichomonas species in two patients with pleural empyema.

    PubMed

    Lopez-Escamilla, Eduardo; Sanchez-Aguillon, Fabiola; Alatorre-Fernandez, Cynthia Pamela; Aguilar-Zapata, Daniel; Arroyo-Escalante, Sara; Arellano, Teresa; Moncada-Barron, David; Romero-Valdovinos, Mirza; Martinez-Hernandez, Fernando; Rodriguez-Zulueta, Patricia; Maravilla, Pablo

    2013-09-01

    Two unusual occurrences of pleural trichomonosis due to a new Tetratrichomonas species previously reported but not named were confirmed. In one patient, Trichomonas tenax and a Tetratrichomonas species were also detected in the oral cavity by molecular methods. We suggest that this new Tetratrichomonas species be named Tetratrichomonas empyemagena. PMID:23784131

  17. Pleural Epithelioid Hemangioendothelioma: A Case Report and Literature Review.

    PubMed

    Fan, Yingqi; Wang, Faping; Li, Suyun; Ye, Cheng; Ying, Ying; Mao, Hui

    2016-05-01

    Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin that can arise in multiple and varied tissue sites. Pleural epithelioid hemangioendothelioma (PEH), a subtype of EHE, is particularly less reported. Herein, we describe a case of PEH presented with left-sided back pain in a 68-year-old female, and her chest CT scan revealed thickening of the left pleura and left pleural effusion, the histological diagnosis was confirmed by both conventional examination and immunohistochemistry. A literature search utilizing PubMed, Embase, Ovid and Cochrane, Wanfang and Chinese National Knowledge infrastructure (CNKI) for PEH was conducted to investigate the characteristics of the disease, 26 related articles were retrieved and 40 cases of PEH were reported. According to available literature, the average age at presentation is 51.8 years and the disease occurred more often in men than women. The etiology of the disease remained unknown. Chest pain, cough, and dyspnea were the common symptoms. Computed tomography usually revealed pleural effusion and pleural thickening. Histological examinations revealed mainly epithelioid cells. Immunohistochemical stains were positive for vascular endothelial markers. PEH tends to have more aggressive behavior than tumors in other locations, thus effective treatment has not yet been established until now. Further studies are needed to analyze the prognostic factors, clinical features and treatment of PEH. PMID:27372473

  18. Procalcitonin and Other Biomarkers of Sepsis in Newborns in the Intensive Care Unit

    PubMed Central

    Ignjatovic, Svetlana; Stankovic, Sanja; Nada Majkić, Singh

    2011-01-01

    Neonatal sepsis is one of the most significant causes of mortality and morbidity in infants. Among numerous parameters available to confirm the presence of sepsis in newborns procalcitonin (PCT) has been chosen. The aim of this study was the determination of PCT, C-reactive protein (CRP) serum amyloid A (SAA), plasminogen, protein C, antithrombin III (AT III) and white blood cell count (WBC) in blood sample obtained by puncture of the umbilical vein. Sixty two newborn infants were included in the study: 31 with suspected bacterial infection and 31 healthy babies Serum procalcitonin was measured using Kryptor analyzer (Brahms Aktiengesellschaft, Germany); serum hsCRP and SAA on the Behring Nephelometer II (Dade Behring Diagnostics GmbH, Marburg, Germany); plasma plasminogen, protein C and AT III on BCT Coagulation system, (Dade Behring Diagnostics GmbH, Marburg, Germany); and WBC count was determined in the whole blood using hematological analyzer ADVIA 120 Hematology System (Bayer, Germany). The obtained mean values of PCT, hsCRP, SAA, WBC, plasminogen, AT III, protein C in newborn’s samples with suspected bacterial infection/healthy newborns were: 0.188 ng/L / 0.121 ng/L; 1.20 mg/L / 1.30 mg/L, 1.28% / 1.70%; 16.0 x 109/L/12.0 x 109 / L, 61.0% / 59.0%, 52.0% / 64.5%, 39.0% / 41.0%, respectively. Neonates with bacterial infection had significantly higher values of PCT (p <0.001), WBC (p <0.001) and CRP (p <0.05) compared to healthy babies. Based on these results, it may be concluded that procalcitonin is useful for early diagnosis of sepsis in newborns.

  19. A fluorescent immunoassay for the determination of procalcitonin and C-reactive protein

    NASA Astrophysics Data System (ADS)

    Baldini, F.; Bolzoni, L.; Giannetti, A.; Porro, G.; Senesi, F.; Trono, C.

    2009-05-01

    The discrimination of viral and bacterial sepsis is an important issue in intensive care patients. For this purpose, the simultaneous measurements of different analytes such as C-reactive protein (CRP), procalcitonin (PCT), myeloperoxidase, interleukines and neopterin, are necessary. A novel optical platform was designed and realised for the implementation of fluorescence-based immunoassays. The core of the optical platform is a plastic biochip, formed by a series of microchannels each of them devoted to the determination of a single analyte. Sandwich assays for CRP and PCT spiked in serum were performed in order to demonstrate the reliability of a multi-array device.

  20. Utility of blood procalcitonin concentration in the management of cancer patients with infections

    PubMed Central

    Durnaś, Bonita; Wątek, Marzena; Wollny, Tomasz; Niemirowicz, Katarzyna; Marzec, Michał; Bucki, Robert; Góźdź, Stanisław

    2016-01-01

    Diagnosis of infections in cancer patients is usually problematic since differentiating between infection and fever of unknown origin is often a considerable clinical challenge. In general, increase concentration of blood procalcitonin (PCT) is associated with severe bacterial infection. PCT with an optimal cutoff level of 0.5 ng/mL seems to be the most helpful biochemical parameter in detecting severe infections, mainly bloodstream infection, in patients with hematological cancers. In all clinical situations, the elevated level of PCT should be carefully analyzed, always with a thorough physical examination and an appropriate microbiological assessment. PMID:26858528

  1. Relationship of the serum procalcitonin level with the severity of acute pancreatitis.

    PubMed

    Sato, Nobuhiro; Endo, Shigeatsu; Kasai, Takeshi; Inoue, Yoshihiro; Fujino, Yasuhisa; Onodera, Makoto; Imai, Satoko; Takahashi, Gaku; Miyata, Michiko; Kitamura, Michihiko; Wakabayashi, Go

    2004-01-01

    The procalcitonin (PCT) level in the blood was determined in cases of acute pancreatitis. The PCT level was found to show a significant correlation with the severity of acute pancreatitis. Furthermore, the PCT level was significantly higher in the cases which developed MODS than in those which did not. The PCT level was significantly higher in the patients who eventually died than in those who survived. A significant correlation was observed between the serum PCT level and the serum tumor necrosis factor alpha level. Thus, PCT level was found to be a reliable indicator of the severity of acute pancreatitis.

  2. [Analytical interference in determination of procalcitonin by PCT-Q (Brahms)].

    PubMed

    Désidéri-Vaillant, C; Rouby, Y; Cardon, N; Vinsonneau, U; Laborde, J-P

    2006-05-01

    Procalcitonin (PCT) is a biological marker of infection. We present the cas of a patient who has presented a high concentration of PCT with PCT-Q test (Brahms). At the same time, the concentration of CRP is remained low, which is no physiological. Then, PCT concentration has been determinated with an automatic system (Kryptor-Brahms) and finded at low than 0.5 microg/l. Brahms company has searched an analytical interference: human anti-mouse antibodies (HAMA) were positive. If PCT concentration stay a marker of infection for the most part, this case show that biologists have to keep in mind that immunological assays remain submitted to interferences.

  3. Procalcitonin Biomarker Kinetics to Predict Multiorgan Dysfunction Syndrome in Children With Sepsis and Systemic Inflammatory Response Syndrome

    PubMed Central

    Zurek, Jiri; Vavrina, Martin

    2015-01-01

    Background: Procalcitonin (PCT) kinetics is a good prognosis marker in infectious diseases, but few studies of children sepsis have been performed. Objectives: The aim of our study was to examine kinetics of procalcitonin, to evaluate its relationship with severity and to analyze its usefulness in the prediction of multiorgan dysfunction syndrome (MODS). Patients and Methods: Prospective observational study in an 8-bed pediatric intensive care unit of a university hospital. Sixty-two children aged 0-19 years with systemic inflammatory response syndrome or septic states. The degree of severity was evaluated according pediatric logistic organ dysfunction (PELOD) score. Blood tests to determine levels of PCT were taken if the patients had the criteria of systemic inflammatory response syndrome or sepsis. The serum to determine levels of PCT in control group has been taken from patients undergoing elective surgery. Results: Higher values of PCT were identified in patients with PELOD score 12 and more compared to those with PELOD < 12 (P = 0.016). Similarly, higher PCT values were found in patients who developed MODS in contrast to those without MODS (P = 0.011). According to ROC analysis cut-off value of 4.05 ng/mL was found to best discriminate patients with PELOD < 12 and PELOD ≥ 12 with AUC = 0.675 (P = 0.035). Effect of procalcitonin levels on mortality was not demonstrated. Conclusions: Levels of procalcitonin from day 1 to day 5 are related to the severity and multiorgan dysfunction syndrome in children. PMID:26199699

  4. A 30-year-old female Behçet's disease patient with recurrent pleural and pericardial effusion and elevated adenosine deaminase levels: case report.

    PubMed

    Choi, Joon Young; Kim, Sung-Hwan; Kwok, Seung-Ki; Jung, Jung Im; Lee, Kyo-Young; Kim, Tae-Jung; Kang, Ji Young

    2016-07-01

    Behçet's disease is a systemic disease which may involve various organs. We describe a case of a patient diagnosed as pleuropericardial involvement of Behçet's disease. A 30-year-old woman visited our clinic presented with left pleuritic chest pain for s days. She had been diagnosed as Behçet's disease and admitted to our clinic due to pericardial and pleural effusion repeatedly in past two years. In the previous studies, effusion analysis revealed to be lympho-dominant exudate with high adenosine deaminase level. Acid-fast bacilli (AFB) culture and polymerase chain reaction (PCR) for mycobacterial tuberculosis (M.TB) were negative in the pericardial tissue, and pathologic finding showed mild endothelitis with micro-thrombi formation in the lumen. The patient had been treated with antituberculous medication for a year. In the current admission, chest computed tomography (CT) again showed left pleural effusion without other significant lesion. Pleural fluid analysis was similar with the previous study. Video-assisted thoracoscopic pleural biopsy was performed to obtain the definite diagnosis. Pathology confirmed the diagnosis as pleuropericardial involvement of Behçet's disease, and we treated the patient with oral steroid in the out-patient department. Pleuropericardial involvement of Behçet's disease may mimic TB pleurisy or pericarditis due to high adenosine deaminase (ADA) level in effusion analysis. Clinicians should keep in mind that Behçet's disease may manifest as pleural or pericardial effusion, and pathologic confirmation could be helpful for the definite diagnosis. PMID:27499994

  5. A 30-year-old female Behçet’s disease patient with recurrent pleural and pericardial effusion and elevated adenosine deaminase levels: case report

    PubMed Central

    Choi, Joon Young; Kim, Sung-Hwan; Kwok, Seung-Ki; Jung, Jung Im; Lee, Kyo-Young; Kim, Tae-Jung

    2016-01-01

    Behçet’s disease is a systemic disease which may involve various organs. We describe a case of a patient diagnosed as pleuropericardial involvement of Behçet’s disease. A 30-year-old woman visited our clinic presented with left pleuritic chest pain for s days. She had been diagnosed as Behçet’s disease and admitted to our clinic due to pericardial and pleural effusion repeatedly in past two years. In the previous studies, effusion analysis revealed to be lympho-dominant exudate with high adenosine deaminase level. Acid-fast bacilli (AFB) culture and polymerase chain reaction (PCR) for mycobacterial tuberculosis (M.TB) were negative in the pericardial tissue, and pathologic finding showed mild endothelitis with micro-thrombi formation in the lumen. The patient had been treated with antituberculous medication for a year. In the current admission, chest computed tomography (CT) again showed left pleural effusion without other significant lesion. Pleural fluid analysis was similar with the previous study. Video-assisted thoracoscopic pleural biopsy was performed to obtain the definite diagnosis. Pathology confirmed the diagnosis as pleuropericardial involvement of Behçet’s disease, and we treated the patient with oral steroid in the out-patient department. Pleuropericardial involvement of Behçet’s disease may mimic TB pleurisy or pericarditis due to high adenosine deaminase (ADA) level in effusion analysis. Clinicians should keep in mind that Behçet’s disease may manifest as pleural or pericardial effusion, and pathologic confirmation could be helpful for the definite diagnosis. PMID:27499994

  6. Fluid imbalance

    MedlinePlus

    ... fluid imbalance; Hypernatremia - fluid imbalance; Hypokalemia - fluid imbalance; Hyperkalemia - fluid imbalance ... of sodium or potassium is present as well. Medicines can also affect fluid balance. The most common ...

  7. Clinical and Cost-Effectiveness of Procalcitonin Test for Prodromal Meningococcal Disease–A Meta-Analysis

    PubMed Central

    Shields, Michael D.; Dunlop, Kathryn; Bourke, Thomas; Kee, Frank

    2015-01-01

    Background Despite vaccines and improved medical intensive care, clinicians must continue to be vigilant of possible Meningococcal Disease in children. The objective was to establish if the procalcitonin test was a cost-effective adjunct for prodromal Meningococcal Disease in children presenting at emergency department with fever without source. Methods and Findings Data to evaluate procalcitonin, C-reactive protein and white cell count tests as indicators of Meningococcal Disease were collected from six independent studies identified through a systematic literature search, applying PRISMA guidelines. The data included 881 children with fever without source in developed countries.The optimal cut-off value for the procalcitonin, C-reactive protein and white cell count tests, each as an indicator of Meningococcal Disease, was determined. Summary Receiver Operator Curve analysis determined the overall diagnostic performance of each test with 95% confidence intervals. A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with fever without source by comparing two diagnostic strategies: standard testing using combined C-reactive protein and white cell count tests compared to standard testing plus procalcitonin test. The costs of each of the four diagnosis groups (true positive, false negative, true negative and false positive) were assessed from a National Health Service payer perspective. The procalcitonin test was more accurate (sensitivity=0.89, 95%CI=0.76-0.96; specificity=0.74, 95%CI=0.4-0.92) for early Meningococcal Disease compared to standard testing alone (sensitivity=0.47, 95%CI=0.32-0.62; specificity=0.8, 95% CI=0.64-0.9). Decision analytic model outcomes indicated that the incremental cost effectiveness ratio for the base case was £-8,137.25 (US $ -13,371.94) per correctly treated patient. Conclusions Procalcitonin plus standard recommended tests, improved the discriminatory ability for fatal Meningococcal

  8. Elevation of procalcitonin after implantation of an interventional lung assist device in critically ill patients.

    PubMed

    Kott, Matthias; Bewig, Burkhard; Zick, Günther; Schaedler, Dirk; Becher, Tobias; Frerichs, Inéz; Weiler, Norbert

    2014-01-01

    A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial therapy increases the mortality in this group of high-risk critically ill patients, whereas overtreatment promotes bacterial resistance and leads to increased drug toxicity and costs. Besides clinical signs and symptoms, antimicrobial treatment is based on the kinetics of biomarkers such as procalcitonin (PCT). We hereby report an up to 10-fold increase in PCT serum concentrations in four mechanically ventilated patients with ARDS detected within 12-20 hours after iLA implantation in the absence of any infection. Procalcitonin concentrations returned to nearly baseline values in all patients on the fourth day after iLA implantation. We discuss the possible mechanisms of PCT induction in this specific patient population and recommend the onset of antibiotics administration after iLA implantation to be carefully considered in the context of other clinical findings and not solely based on the PCT kinetics. Repeated PCT measurements in short time intervals should be performed in these patients.

  9. Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients

    PubMed Central

    Mokline, A.; Garsallah, L.; Rahmani, I.; Jerbi, K.; Oueslati, H.; Tlaili, S.; Hammouda, R.; Gasri, B.; Messadi, A.A.

    2015-01-01

    Summary The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. Serum PCT was measured over the entire course of stay in patients with predictive signs of sepsis according to the Americain Burn Association Criteria for the presence of infection. Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy. PMID:27252609

  10. Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients.

    PubMed

    Mokline, A; Garsallah, L; Rahmani, I; Jerbi, K; Oueslati, H; Tlaili, S; Hammouda, R; Gasri, B; Messadi, A A

    2015-06-30

    The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. Serum PCT was measured over the entire course of stay in patients with predictive signs of sepsis according to the Americain Burn Association Criteria for the presence of infection. Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy.

  11. Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation

    PubMed Central

    Stirkat, Falk; Croner, Roland S.; Vassos, Nikolaos; Raptis, Dimitrios; Yedibela, Süleyman; Hohenberger, Werner; Müller, Volker

    2016-01-01

    Introduction The aim of the study was to assess the diagnostic accuracy of procalcitonin (PCT) as a marker for complications and as a prognostic factor for mortality after liver transplantation. Material and methods Liver transplant patients between January 2007 and April 2011 were prospectively included in the study. Procalcitonin serum concentration was recorded before, 6 h after reperfusion and then daily. Postoperative clinical course was prospectively analyzed from admission to discharge. Main surgical data such as operating procedure, type of reperfusion, operating and ischemic times, high urgency (HU) status and MELD score at the time of transplantation were also recorded. Results Sixteen patients with initial PCT > 5 ng/ml suffered ≥ 1 complication (p = 0.03). However, there was no association between the level of the 1st peak PCT and the further postoperative course or the occurrence of complications. Patients in whom a 2nd PCT peak occurred had a significantly higher risk for a complicated course, for a complicated sepsis course and for mortality (p < 0.0001). Warm ischemic time over 58 min, operating time over 389 min and HU status were significant independent factors for a complicated postoperative course (p < 0.001, p < 0.001 and p = 0.03 respectively). Conclusions Based on our results, we believe that PCT course and the occurrence of a 2nd peak seem to possess important diagnostic and prognostic power in the post-transplant setting after liver transplantation. PMID:27186183

  12. Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients.

    PubMed

    Mokline, A; Garsallah, L; Rahmani, I; Jerbi, K; Oueslati, H; Tlaili, S; Hammouda, R; Gasri, B; Messadi, A A

    2015-06-30

    The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. Serum PCT was measured over the entire course of stay in patients with predictive signs of sepsis according to the Americain Burn Association Criteria for the presence of infection. Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy. PMID:27252609

  13. Use of lateral flow assays to determine IP-10 and CCL4 levels in pleural effusions and whole blood for TB diagnosis.

    PubMed

    Sutherland, Jayne S; Mendy, Joseph; Gindeh, Awa; Walzl, Gerhard; Togun, Toyin; Owolabi, Olumuyiwa; Donkor, Simon; Ota, Martin O; Kon Fat, Elisa Tjon; Ottenhoff, Tom H M; Geluk, Annemieke; Corstjens, Paul L A M

    2016-01-01

    One of the key problems in combating TB is the lack of fast and accurate diagnostic tests that are affordable and easy to use in resource-limited settings. We have used a field-friendly up-converting phosphor (UCP) reporter technology in a lateral flow (LF) based test for the diagnosis of respiratory infections. In this study we analysed samples obtained from patients presenting with symptoms suggestive of TB but prior to confirmation by microbiology in The Gambia. Following clinical and microbiological evaluation they were classified as either having TB or other respiratory disorder (ORD). Analysis of blood was performed for those with pulmonary TB and pleural fluid for those with pleural TB. UCP-LF test for detection and quantitation of IP-10 and CCL4 were used being the two chemokine markers that have been shown to increase in active TB disease. UCP-LF test accurately determined concentrations of both markers as compared to ELISA and multiplex cytokine array. However, only IP-10 could discriminate between TB and ORD, and this was significantly enhanced by analysing the site of infection (pleural fluid), which showed 92% correct classification. Future work will assess the use of multiple markers to increase diagnostic accuracy.

  14. [Pleural hernia of an esophageal graft--late postoperative complication].

    PubMed

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  15. Pleural effusion Due to Streptococcus milleri: Case descriptions.

    PubMed

    Madrid-Carbajal, Claudia Janeth; Molinos, Luis; García-Clemente, Marta; Pando-Sandoval, Ana; Fleites, Ana; Casan-Clarà, Pere

    2014-09-01

    In this study we analyzed the characteristics of patients with pleural effusion secondary to Streptococcus milleri studied retrospectively between January and March 2013 and found seven patients with a mean age of 60 years, 43% of which were smokers and 57% with a drinking habit. The most common associated factors were alcoholism, previous pneumonia and diabetes. Other bacteria were identified as Enterobacter aerogenes, Bacteroides and Prevotella intermedia capillosus in two patients. The mean duration of antibiotic therapy was 28 days; six patients underwent pleural drainage by chest tube and one patient needed surgery due to poor clinical progress. The mean duration of hospitalization was 30 days with satisfactory outcome in all cases, despite some changes in residual function.

  16. Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis.

    PubMed Central

    Miller, A

    1990-01-01

    Four patients occupationally exposed to asbestos, each suffering at least eight years of disabling, persistent, and often bilateral pleuritic pain are described. Radiographic evidence of pleural disease ranged from plaques seen only on computed tomography to typical bilateral plaques or diffuse thickening to extensive diffuse and circumscribed pleural fibrosis and calcification. There was no history or evidence of acute pleuritis or pleural effusion in three patients. Intermittent pleural friction rubs have been present in all four; one patient showed pleural uptake of gallium-67. Extensive workups including repeated pulmonary ventilation-perfusion scans and cardiac catheterisation have not yielded other diagnoses to explain the pain. It is proposed that persistent pleuritic pain be added to the manifestations of benign asbestos induced pleural disease. Images PMID:2328221

  17. [The computed tomographic diagnosis of malignant pleural mesothelioma. A multicenter study].

    PubMed

    Falaschi, F; Boraschi, P; Musante, F; Volpini, F; D'Alessandro, F; Torri, T; Barbieri, L

    1992-01-01

    CT features are described and accuracy of the method is discussed in the diagnosis of malignant pleural mesothelioma. Ninety-eight patients suffering from pleural disease mimicking mesothelioma were examined by means of III-generation CT scanners; according to the final diagnosis, 37 patients suffered from malignant pleural mesothelioma, 27 from other malignant pleural diseases and 34 from various benign diseases. In all patients a series of CT signs was evaluated: pleural thickening patterns, lesion spread and possible associated characters. In the diagnosis of mesothelioma CT showed 72.5% sensitivity, 63.8% specificity, 68.3% diagnostic accuracy, 68.5% positive predictive value and 68.2% negative predictive value. Some significant CT patterns in distinguishing malignant from benign pleural disease were identified, while the characterization of malignant disease (mesothelioma versus other neoplastic conditions) proved to be unreliable.

  18. Localized malignant pleural sarcomatoid mesothelioma misdiagnosed as benign localized fibrous tumor

    PubMed Central

    Vo, Hong-Phuc

    2016-01-01

    Localized malignant pleural mesothelioma (LMPM) is a rare tumor with good prognosis by surgical resection. We report an atypical case of malignant pleural sarcomatoid mesothelioma (SM) in an asymptomatic 65-year-old woman, who had no history of exposure to asbestos. She presented with a small pleural mass without pleural effusion and was misdiagnosed as a benign localized fibrous tumor (BLFT) on pathologic examination through a surgical tumor specimen. However, seven months later, the patient returned with serious cancerous symptoms. A large recurrent tumor mass was found within the chest wall invading at the old surgical resection site. SM, a subtype of LMPM, was confirmed with histopathogy and immunohistochemisty. In conclusion, malignant pleural mesothelioma (MPM) can present with typical radiologic finding similar to a BLFT, and has a wide histopathologic presentation in biopsy specimen. A thorough pathologic investigation should be attempted even when a pleural mass resembles benign, localized, and small on radiologic studies. PMID:27293862

  19. Symptomatic benign pleural effusions among asbestos insulation workers: residual radiographic abnormalities.

    PubMed Central

    Lilis, R; Lerman, Y; Selikoff, I J

    1988-01-01

    During a cross sectional medical survey of 2815 insulation workers with 30 years or more from onset of asbestos exposure conducted from 1981 to 1983, a positive history of benign pleural effusion was found in 20 (0.71%). Two or three such episodes had occurred in four of these 20 subjects. The chest x ray abnormalities in these cases were characterised by pleural fibrosis in 19 and diffuse pleural fibrosis with blunting of the corresponding costophrenic angle in 16. In the total group of 2815 insulation workers diffuse pleural fibrosis was found in 142 (5.0%). Thus diffuse pleural fibrosis with blunting of the corresponding costophrenic angle is a frequent residual abnormality after benign pleural effusion. Its impact on pulmonary function can be pronounced. Images PMID:3260799

  20. Localized malignant pleural sarcomatoid mesothelioma misdiagnosed as benign localized fibrous tumor.

    PubMed

    Kim, Kwan-Chang; Vo, Hong-Phuc

    2016-06-01

    Localized malignant pleural mesothelioma (LMPM) is a rare tumor with good prognosis by surgical resection. We report an atypical case of malignant pleural sarcomatoid mesothelioma (SM) in an asymptomatic 65-year-old woman, who had no history of exposure to asbestos. She presented with a small pleural mass without pleural effusion and was misdiagnosed as a benign localized fibrous tumor (BLFT) on pathologic examination through a surgical tumor specimen. However, seven months later, the patient returned with serious cancerous symptoms. A large recurrent tumor mass was found within the chest wall invading at the old surgical resection site. SM, a subtype of LMPM, was confirmed with histopathogy and immunohistochemisty. In conclusion, malignant pleural mesothelioma (MPM) can present with typical radiologic finding similar to a BLFT, and has a wide histopathologic presentation in biopsy specimen. A thorough pathologic investigation should be attempted even when a pleural mass resembles benign, localized, and small on radiologic studies. PMID:27293862

  1. Management of anthracycline extravasation into the pleural space

    PubMed Central

    Chang, Rachael; Murray, Nick

    2016-01-01

    Anthracycline extravasation is a feared complication of intravenous (i.v.) chemotherapy due to the tissue toxicity of this group of drugs. We describe a 54-year-old woman with history of stage IIIa breast cancer, receiving adjuvant chemotherapy consisting of doxorubicin and cyclophosphamide. The chemotherapy was administered through a Poweport® device, the position of which was confirmed with fluoroscopy and function confirmed by flushing the line. Urgent intervention was required as patient was symptomatic and experienced severe right-sided pleuritic chest pain. Radiology also confirmed the extravasation of doxorubicin into the pleural space. Surgical washout of the pleural space and 3 days therapy with i.v. dexrazoxane were carried out to prevent tissue damage and long-term sequelae. Use of dexrazoxane should always be considered following intra-pleural extravasation because of its potential efficacy and reasonable tolerability. However, the best approach to extravasation injury is prevention by systematic implementation of careful, standardized, evidence-based administration techniques. PMID:27699056

  2. Pleural plaques in a rural population in central Macedonia, Greece.

    PubMed

    Sichletidis, L; Daskalopoulou, E; Chloros, D; Vlachogiannis, E; Vamvalis, C

    1992-01-01

    The aim of this study was to investigate the prevalence and the causative factor of pleural plaques (PP) in 7 neighbouring villages (Monastiraki, Promachi, Megaplatanos, Orma, Polykarpi, Sarakini and Koryphi) located south-west of Aridea in Macedonia, Greece, where many cases of bilateral pleural calcifications were observed in the past. Full size chest radiographs were obtained from 1086 of the 3901 inhabitants over 5 years of age who agreed to participate in the study. The chest radiographs were scrutinized for PP according to International Labour Office criteria. From the total of 1737 inhabitants aged between 5 and 40 years, 268 were examined. None had a positive chest radiograph for PP. Therefore the prevalence of PP was evaluated for the subjects over 40 years of age. The highest prevalence of PP (41.7%) was observed in Monastiraki and none in Koryphi, with the prevalence of the other villages lying in between. Extremely high concentrations of chrysotile and tremolite fibres were found, using polarised light microscopy and X-ray diffraction, in the "white stones" which people use for white-washing their houses prior to 1935. The environmental study revealed 0.01 fibres/ml in a room purposely recently painted with the offending material, and 17.9 ff/ml after scraping. During the 28 months of our study five cases of malignant pleural mesothelioma were diagnosed.

  3. Pleural mesotheliomas are underreported as occupational cancer in Sweden.

    PubMed

    Andersson, E; Torén, K

    1995-04-01

    The aim of this study was to estimate to what degree malignant pleural mesotheliomas were reported as occupational cancers. The study included all malignant pleural mesotheliomas (n = 210) found in the Cancer Registry 1980-1989 from four Swedish counties. Whether or not a case was reported as occupational cancer was found in the Swedish Register of Reported Occupational Diseases. To evaluate the presence of exposure histories, the chest department files for 58 mesotheliomas from one county were reviewed. The reporting was low, with only 75 mesotheliomas (36%) reported. All the cases were men, and for the men, the reporting frequency was 42%. The reporting was significantly lower for the last part of the decade than for the first part. The reporting frequency decreased with age. In the review of the chest department files, an exposure history was found in 93% of the reported cases and in 47% of the unreported cases. It is concluded that physicians must give more priority to exposure histories in patients with pleural mesotheliomas.

  4. Management of anthracycline extravasation into the pleural space

    PubMed Central

    Chang, Rachael; Murray, Nick

    2016-01-01

    Anthracycline extravasation is a feared complication of intravenous (i.v.) chemotherapy due to the tissue toxicity of this group of drugs. We describe a 54-year-old woman with history of stage IIIa breast cancer, receiving adjuvant chemotherapy consisting of doxorubicin and cyclophosphamide. The chemotherapy was administered through a Poweport® device, the position of which was confirmed with fluoroscopy and function confirmed by flushing the line. Urgent intervention was required as patient was symptomatic and experienced severe right-sided pleuritic chest pain. Radiology also confirmed the extravasation of doxorubicin into the pleural space. Surgical washout of the pleural space and 3 days therapy with i.v. dexrazoxane were carried out to prevent tissue damage and long-term sequelae. Use of dexrazoxane should always be considered following intra-pleural extravasation because of its potential efficacy and reasonable tolerability. However, the best approach to extravasation injury is prevention by systematic implementation of careful, standardized, evidence-based administration techniques.

  5. Regional differences in pleural lymphatic albumin concentration in sheep

    SciTech Connect

    Albertine, K.H.; Schultz, E.L.; Wiener-Kronish, J.P.; Staub, N.C.

    1987-01-01

    We used quantitative reflectance autoradiography to compare the concentration of albumin in visceral pleural lymphatics at the cranial and caudal ends of the sheep's lung in the vertical (60 degrees head-up) and horizontal (supine) positions. Twelve to fourteen hours after injecting 125I-albumin intravenously we placed four anesthetized sheep in the vertical position to establish a microvascular hydrostatic pressure gradient along the vertical height of the lung. We placed two anesthetized sheep in the horizontal position. Four hours later, we fixed the left lung and removed visceral pleural tissue blocks from the cranial and caudal ends, separated by a 15-cm distance, along the costovertebral margin. We measured the silver grain density in the pleural lymphatic autoradiograms by dark-field reflectance microspectrophotometry. In the vertical position, the lymph albumin concentration at the cranial end (top) of the lung averaged 2.5 +/- 0.4 g/dl compared with the caudal end (bottom), which averaged 1.8 +/- 0.3 g/dl. The difference (42% greater at the top than the bottom) is significant (P less than 0.05). The computed gradient in perimicrovascular interstitial albumin osmotic pressure was 0.26 +/- 0.13 cmH2O/cm lung height. There were no differences between the cranial and caudal lymphatic groups in the two horizontal sheep. We conclude that in the sheep lung there is a gradient in perimicrovascular albumin concentration due to the vertical gradient in microvascular hydrostatic pressure.

  6. Corynebacterium parvum versus tetracycline as pleural sclerosing agents in rabbits.

    PubMed

    Vargas, F S; Wang, N S; Teixeira, L R; Carmo, A O; Silva, L M; Light, R W

    1995-12-01

    Tetracycline has been one of the most commonly used agents for producing a pleurodesis. However, it is no longer available due to more stringent requirements on the manufacturing process. The objective of this project was to determine whether Corynebacterium parvum is an effective sclerosant in an experimental model in rabbits. The following medications were instilled intrapleurally in anaesthetized male rabbits: tetracycline 35 mg.kg-1 or C. parvum 4 or 8 mg, all diluted with bacteriostatic saline solution. Twenty eight days after the instillation, the animals were sacrificed and the pleural spaces assessed macroscopically for evidence of pleurodesis and microscopically for evidence of fibrosis and inflammation. The intrapleural injection of C. parvum was ineffective in creating pleural fibrosis. The mean degree of pleurodesis in the 10 rabbits who received tetracycline was 3.5 +/- 0.7 (scale 0-4) whilst in the 10 rabbits that received 4 mg C. parvum it was 0.0 +/- 0.0, and in the 10 rabbits that received 8 mg C. parvum it was 0.5 +/- 0.8. Based on this study, we recommend that C. parvum should not be used as a pleural sclerosant in patients with normal pleura. PMID:8666113

  7. Pleural plaques and risk of cancer in Turin, northwestern Italy. An autopsy study

    SciTech Connect

    Mollo, F.; Andrion, A.; Colombo, A.; Segnan, N.; Pira, E.

    1984-10-01

    The relationship between the occurrence of neoplastic diseases and the presence of pleural plaques was studied in a series of 1097 autopsies performed in Turin from the adult general population. In men, pleural plaques showed an association with the presence of laryngeal, pulmonary, esophageal, and colorectal cancer. Only cancer of the larynx was strongly related to the occurrence of such pleural changes. This autopsy investigation confirms previous observations by others based on x-ray findings, and suggests that pleural plaques may be regarded as risk indicators of possibly asbestos-related tumors in the general population.

  8. Serum procalcitonin in the diagnosis and management of intra-abdominal infections.

    PubMed

    Watkins, Richard R; Lemonovich, Tracy L

    2012-02-01

    The biomarker procalcitonin (PCT) has been used to diagnose and monitor a number of clinically significant infections. Serum levels of PCT are often increased in the presence of bacterial and fungal infections but not viral infections or noninfectious inflammation. Intra-abdominal infections (IAIs) are serious conditions that pose difficult challenges to physicians and the healthcare system. Researchers have evaluated PCT in the management of IAIs, both for diagnosis and for guiding antibiotic therapy. The studies have produced mixed results, leading to controversy on the utility of PCT in IAIs. PCT appears to be most useful in diagnosing postoperative infections and necrotizing pancreatitis. This review aims to summarize these data, explore the pathophysiology of PCT in sepsis from IAIs, discuss the strengths and weaknesses of PCT monitoring in IAIs, and provide guidance for the interpretation of PCT levels.

  9. Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?

    PubMed

    Meili, Marc; Müller, Beat; Kulkarni, Prasad; Schütz, Philipp

    2015-10-01

    Use of inflammatory biomarkers to guide antibiotic decisions has shown promising results in the risk-adapted management of respiratory tract infections, mainly in the inpatient setting. Several observational and interventional trials have investigated the benefits of procalcitonin (PCT) and C-reactive protein (CRP) testing in primary care. Both markers have shown promising results, although CRP is an inflammatory biomarker while PCT is more specific for bacterial infections. For CRP, point-of-care testing is widely established. Recently, sensitive point-of-care testing for PCT has also become available. A high-quality trial comparing these two markers for the management of patients in primary care is currently lacking. The aim of this paper is to review the existing literature investigating the use of PCT and CRP in primary care. The authors compare their performance for guiding antibiotic stewardship and analyze the cut-off values and endpoints to put these parameters into context in a low-acuity environment.

  10. Measurements of procalcitonin facilitate targeting of endotoxin adsorption treatment in febrile neutropenic patients suffering from shock.

    PubMed

    Hara, Masaki; Tsuchiya, Ken; Nitta, Kosaku; Ando, Minoru

    2014-01-01

    Immediate initiation of hemoperfusion treatment with polymixin B immobilized fiber (PMX-DHP) is a potent strategy to improve hemodynamics in septic patients with critical circulatory failure. However, it is often difficult to accurately and rapidly differentiate between bacterial infections and non-infectious causes of shock in acutely critically-ill patients. Procalcitonin (PCT) measurements may assist in the early identification of bacterial infection/sepsis and determination of severity in such patients. We present two febrile neutropenic (FN) patients who developed severe shock after chemotherapy for hematological malignancies. PCT levels were markedly elevated in both patients (≥ 10 ng/ml), suggesting a high likelihood of bacterial infectious etiology as the cause of their shock, and thus they were promptly treated with PMX-DHP. Measurements of PCT may facilitate targeting of PMX-DHP treatment among FN patients suffering from shock, which may lead to better prognosis.

  11. Electrochemical immunoassay for procalcitonin antigen detection based on signal amplification strategy of multiple nanocomposites.

    PubMed

    Fang, Yi-Shan; Wang, Hai-Ying; Wang, Li-Shi; Wang, Ju-Fang

    2014-01-15

    Procalcitonin, as a medium of inflammation, has become a new marker of the identification of severe bacterial infections in recent years and has received high attention due to its most ideal diagnostic indicators of specificity with major types of organism systemic inflammation of bacterial infection in the early stages. Thus, a novel method for the determination of procalcitonin (PCT) was developed based on a sandwich-type electrochemical immunosensor, which combined a simple immunosensor array as well as an effectively designed trace tag. The immunosensor was fabricated by layer-by-layer coating graphene (GC), carbon nanotubes (MWCNTs), chitosan (CS), glutaraldehyde (GA) composite on the working electrode, which can increase the electronic transfer rate and improve the surface area to capture a large number of primary antibodies (Ab1). The trace tag was prepared by loading high-content signal horseradish peroxidase labeled secondary PCT antibody (HRP-Ab2) with AuNPs, which were coated with mesoporous silica nanoparticles (MCM-41) through thionine linking. In comparison with conventional methods, the proposed immunosensor for PCT provided a better linear response range from 0.01 to 350 ng/mL and a lower limit of detection (LOD) of 0.5 pg/mL under optimal experimental conditions. In addition, the immunosensor exhibited convenience, low cost, rapidity, good specificity, acceptable stability and reproducibility. Moreover, satisfactory results were obtained for the determination of PCT in real human serum samples, indicating that the developed immunoassay has the potential to find application in clinical detection of PCT and other tumor markers as an alternative approach.

  12. Adrenomedullin--A New Marker in Febrile Neutropenia: Comparison With CRP and Procalcitonin.

    PubMed

    Demirkaya, Metin; Tugcu, Deniz; Akcay, Arzu; Aydogan, Gönül; Akıcı, Ferhan; Salcioglu, Zafer; Ekmekci, Hakan; Sevinir, Betül; Balci Ekmekci, Ozlem

    2015-01-01

    In this study, we aimed to determine serum adrenomedullin levels and compare them with levels of C-reactive protein (CRP) and procalcitonin (PCT). Cancer patients aged 0-18 years who experienced febrile neutropenia attacks were included in the study. Adrenomedullin, CRP, and PCT were analyzed at admission, day 3, and days 7-10 later. Fifty episodes of febrile neutropenia that developed in 37 patients were analyzed in this study. The mean age of the patients was 7.5 ± 4.7 (1-18) years. The patients had leukemia (73%), solid tumors (19%), and lymphoma (8%). The percentages of the patients in the clinically documented infection (CDI), fever of unknown origin (FUO), sepsis, and microbiological documented infection (MDI) categories were 34%, 34%, 20%, and 12%, respectively. During the study period, four patients were lost. In the MDI group, adrenomedullin levels on day 3 were significantly higher than those in the CDI and FUO groups. PCT levels were significantly higher in the sepsis group than those in the CDI group at admission, day 3, and days 7-10. In the sepsis group, PCT levels on days 7-10 days were significantly higher than those in the sepsis group. PCT values from the deceased patients on days 7-10 were significantly higher than those from patients who survived. CRP levels did not differ significantly among the febrile neutropenia groups. First, in our study, adrenomedullin was used as a biomarker in the febrile neutropenia episodes of children with cancer. Among adrenomedullin, CRP, and PCT, procalcitonin demonstrates the highest correlation with the severity of infection.

  13. Serum procalcitonin does not differentiate between infection and disease flare in patients with systemic lupus erythematosus.

    PubMed

    Lanoix, J P; Bourgeois, A M; Schmidt, J; Desblache, J; Salle, V; Smail, A; Mazière, J C; Betsou, F; Choukroun, G; Duhaut, P; Ducroix, J P

    2011-02-01

    Systemic erythematosus lupus (SLE) is a common autoimmune disease. Disease flares may mimic infection with fever, inflammatory syndrome and chills, sometimes resulting in a difficult differential diagnosis. Elevated serum procalcitonin (PCT) levels have been reported to be predictive of bacterial infections, but with conflicting results. The value of serum procalcitonin has not been assessed in large series of SLE. We aimed to describe the distribution of PCT levels in SLE patients with and without flares, to assess the factors associated with increased PCT levels, and to determine the positive and negative predictive values of increased PCT for bacterial infection in SLE patients. Hospitalized SLE patients were included in a retrospective study. Serum PCT had been assayed, or a serum sample had been frozen on admission, before treatment modification. Serum PCT, measured by an automated immunofluorometric assay, and SLEDAI were assessed at the same time. Some 53 women (median age: 33.7 years, range 16-76) and seven men (median age: 52.5 years ± 19) were included. The median SLEDAI for patients with flare (n = 16, 28%) was 2 (range: 0-29). Five patients (8%) had systemic infection. Only one patient had increased PCT levels. Men had significantly higher PCT levels than women (0.196 ± 0.23 versus 0.066 ± 0.03, p < 0.01) and a significant correlation was observed between PCT, age, erythrocyte sedimentation rate, and C-reactive protein. We conclude that PCT levels were within the normal range in infected and non-infected SLE patients and there was no ability to differentiate SLE patients with or without bacterial infection. PMID:20937623

  14. Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass.

    PubMed

    Song, L O U; Yinglong, L I U; Jinping, L I U

    2007-09-01

    The abnormal conditions to which blood is subjected during cardiopulmonary bypass (CPB) trigger an activation of the inflammatory response and cause pulmonary dysfunction. It has been suggested that high-volume, zero-balanced ultrafiltration (ZBUF) facilitates clearance of inflammatory mediators and improves post-operative pulmonary function. Procalcitonin, a newly discovered inflammatory mediator, has been found to be increased after CPB and has been proven to be an appropriate parameter for predicting pulmonary dysfunction secondary to CPB. The aim of this study was to investigate the effects of zero-balanced ultrafiltration (ZBUF) on procalcitonin (PCT) and respiratory function of infants with Tetralogy of Fallot (TOF) after CPB. Twenty infants with TOF undergoing open-heart total surgical correction were randomly assigned to two groups. The trial group was given ZBUF (50 ml/kg) and conventional ultrafiltration (CUF), while the control group was given CUF only. Plasma PCT and pulmonary function were monitored and compared between the two groups before the operation (T1), before rewarming (T2), at the end of the operation (T3), and at 12 h, 24 h and 48 h after the operation (T4-T6). PCT was decreased in the trial group between 12 h and 48 h post-operatively, but the differences did not reach statistical significance. The trial group's pulmonary compliance was higher at 12 h post-operatively (p < 0.05). Oxygenation index was increased in the trial group at the end of the operation and 12 h post-operatively (p > 0.05). Intubation time was shorter in the trial group (P < 0.01). A positive correlation was found between peak PCT concentration and intubation time. ZBUF appeared to improve ventilation and shorten intubation time. The improved respiratory function may be due to the lower plasma PCT. PMID:18416220

  15. Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma.

    PubMed

    Tanriverdi, Ozgur; Meydan, Nezih; Barutca, Sabri; Ozsan, Nazan; Gurel, Duygu; Veral, Ali

    2013-05-01

    Paraneoplastic cerebellar degeneration is a rare non-metastatic complication of malignancies. It presents with acute or subacute onset of ataxia, dysarthria and intention tremor. Paraneoplastic cerebellar degeneration is most commonly associated with malignancies of the ovary, breast and lung. The anti-Yo (anti-Purkinje cells) antibodies that specifically damage the Purkinje cells of the cerebellum are found in the serum and cerebrospinal fluid. Anti-Yo-related paraneoplastic cerebellar degeneration is most commonly found in women with gynecological and breast cancers, but it is reported in other malignancies. Patients with paraneoplastic syndromes most often present with neurologic symptoms before an underlying cancer is detected. We report a case of anti-Yo-related paraneoplastic cerebellar degeneration associated with pleural malignant mesothelioma in a 51-year-old female patient. She presented to our department with a 2-week history after the last chemotherapy of progressive dizziness related to head movement, nausea, vomiting, ataxia and unsteady gait. A western blot assay was negative for anti-Hu, anti-Ri, anti-Ma2, anti-CV2 and anti-amphiphysin paraneoplastic antibody markers but positive for anti-Yo. In conclusion, we report a case of paraneoplastic cerebellar degeneration in a patient with pleural malignant mesothelioma because of the rarity of this neurologic presentation after the diagnosis of malignant mesothelioma and of the association with anti-Yo antibodies.

  16. Pneumonia and Pleural Empyema due to a Mixed Lactobacillus spp. Infection as a Possible Early Esophageal Carcinoma Signature

    PubMed Central

    Chaini, Eleftheria; Chainis, Nikolaos D.; Ioannidis, Anastasios; Magana, Maria; Nikolaou, Chryssoula; Papaparaskevas, Joseph; Liakata, Melina-Vassiliki; Katopodis, Panagiotis; Papastavrou, Leonidas; Tegos, George P.; Chatzipanagiotou, Stylianos

    2016-01-01

    Lactobacilli are human commensals found in the gastrointestinal and genitourinary tract. Although generally conceived as non-pathogenic microorganisms, the existence of several reports implicating them in certain severe pathological entities renders this species as opportunistic pathogens. The case of a 58-year-old woman with mixed Lactobacillus infection is described. The patient was admitted in an outpatient clinic with community acquired pneumonia, and on the third day of hospitalization she presented rapid pneumonia deterioration. Subsequent imaging techniques revealed increased pleural empyema in alignment with the general deterioration of her clinical condition. Pleural fluid culture revealed the presence of Lactobacillus delbrueckii and Lactobacillus gasseri and the infection was successfully treated with clindamycin. Five months after hospital discharge and an overall good condition, the patient developed signs of dysphagia and upon re-admission an inoperable esophageal carcinoma was diagnosed. The patient succumbed to the cancer 11 months later. Herein, we report for the first time a mixed respiratory infection due to lactobacilli, possibly associated with a formerly unveiled esophageal malignancy. PMID:27734016

  17. [The value of quantitative analysis of procalcitonine in diagnostics of septic complications in patients with autoimmune rheumatic diseases].

    PubMed

    Lapin, S V; Maslianskiĭ, A L; Lazareva, N M; Vasil'eva, E Iu; Totolian, A A

    2013-01-01

    The infections very often complicate the course of autoimmune rheumatic diseases. In diagnostic of septic complications in rheumatic patients the new biomarkers of infections can have a decisive importance. The procalciotonine test is one of them. The issue was to evaluate the diagnostic informativity of this test. The sample included 93 patients. The examination was applied to 65 patients with rheumatic diseases. Among them, 13 patients had bacterial infections. The group consisted of 33 patients with rheumatoid arthritis, 11 patients with systemic lupus erythematous, 6 patients with systemic angiitis, and 15 patients with other rheumatic diseases. The comparative group included 27 patients of cardio-therapeutic profile and 8 of these patients had bacterial infections. The procalcitonine test was applied with quantitative electrochemiluminescent technique. In patients with rheumatoid arthritis the mean levels of procalciotonine test consisted 0.10 +/- 0.13 ng/ml; with systemic lupus erythematous--0.08 +/- 0.06 ng/ml; with systemic angiitis--0.22 +/- 0.2 ng/ml; with other rheumatic diseases--0.12 +/- 0.15 ng/ml; of cardio-therapeutic profile without infections--0.08 +/- 0.06 ng/vl/ With threshold of procalcitonine test higher than 0.5/ml the sensitivity to diagnostic of infections consisted of 58%, specificity--94% in the group with rheumatic diseases. The procalciotonine test in case of no infection process with values higher than 0.5 ng/ml was detected in three patients. The evaluation of dependence of sensitivity and specificity for procalciotonine test and C-reactive protein the area under curve of procalcitonine test was larger in patients with rheumatic diseases (0.85 against 0.79) and in patients of cardio-therapeutic profile (0.92 against 0.90). The quantitative procalcitonine test is the best technique to detect septic complications in rheumatic patients. PMID:23807991

  18. Pleural mesothelial cells mediate inflammatory and profibrotic responses in talc-induced pleurodesis.

    PubMed

    Acencio, Milena Marques P; Vargas, Francisco S; Marchi, Evaldo; Carnevale, Gabriela G; Teixeira, Lisete R; Antonangelo, Leila; Broaddus, V Courtney

    2007-12-01

    Intrapleural talc is used to produce pleurodesis in malignant pleural effusions. Prior in vivo studies have documented an acute inflammatory response to talc in the pleural space but the cellular source of cytokines has not been identified. The aim of this study was to investigate the acute response of rabbit pleural mesothelial cells challenged with talc used for pleurodesis and compare it to prior studies of the response to talc in the rabbit pleural space. Cultured rabbit pleural mesothelial cells (PMC) were exposed to talc (25 mug/cm(2)) for 6, 24, or 48 h and assessed for viability, necrosis, and apoptosis by flow cytometry, Trypan Blue exclusion, and immunocytochemistry, and for the production of interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), and transforming growth factor-beta(1) (TGF-beta(1)) by ELISA. More than 50% of the PMC remained viable 48 h after talc stimulation. The PMC that were nonviable were identified as either apoptotic or necrotic, with roughly 20% in each category over the 48 h. At 6 h, the IL-8, VEGF, and TGF-beta(1) levels produced by talc-exposed PMC increased significantly and remained elevated for up to 48 h. These cytokine levels rose at similar times and at the same or higher levels than have been measured in the rabbit pleural space in prior studies. We report that viable, talc-exposed, pleural mesothelial cells may actively mediate the primary inflammatory pleural response in talc-induced pleurodesis.

  19. Primary pleural synovial sarcoma presenting as a multiloculated cyst in an adolescent.

    PubMed

    Tailor, J; Roy, P G; Bowker, C; Lakhoo, K

    2008-05-01

    Primary pleural synovial sarcoma (PPSS) is a rare pleural malignancy with a grave prognosis. Most cases present as a well-circumscribed mass with foci of haemorrhage and necrosis. We present an unusual case in a Nepalese boy that presented as a multiloculated cyst mimicking hydatid disease. The diagnosis was confirmed by histology and cytogenetic analysis. PMID:18049822

  20. [Malignant pleural mesothelioma after radiation treatment for Hodgkin lymphoma].

    PubMed

    Vandenbos, F; Figueredo, M; Dumon-Gubeno, M-C; Nicolle, I; Tarhini, A; Butori, C; Mouroux, J

    2013-10-01

    Malignant mesothelioma is a relatively uncommon malignancy. Although the pathogenesis is primarily related to asbestos, the role of ionizing radiation is more controversial. We report the case of a 41-year-old male who developed pleural mesothelioma. He had both, a prior short asbestos exposure and a thoracic radiotherapy for Hodgkin's disease 26years before. The evidence for radiotherapy as cause for mesothelioma is expanding and the diagnosis of mesothelioma in patients who had previous irradiation should be kept in mind. PMID:23796498

  1. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    PubMed Central

    Islam, Julie; Talebi, Soheila; Cativo, Eder; Mushiyev, Savi; Pekler, Gerald; Visco, Ferdinand

    2016-01-01

    Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease. PMID:27807484

  2. Industrial pollution and pleural cancer mortality in Spain.

    PubMed

    López-Abente, Gonzalo; Fernández-Navarro, Pablo; Boldo, Elena; Ramis, Rebeca; García-Pérez, Javier

    2012-05-01

    Pleural cancer mortality is an acknowledged indicator of exposure to asbestos and mesothelioma mortality but in 15%-20% of cases no exposure can be recalled. In the past, asbestos was used in many industries and it is still found in many installations. Our objective was to ascertain whether there might be excess pleural cancer mortality among populations residing in the vicinity of Spanish industrial installations that are governed by the Integrated Pollution Prevention and Control (IPPC) Directive and the European Pollutant Release and Transfer Register Regulation and report their emissions to air. An ecological study was designed to examine pleural cancer mortality at a municipal level (8098 Spanish towns) over the period 1997-2006, during which 2146 deaths were registered. We conducted an exploratory "near vs. far" analysis to estimate the relative risks (RRs) of towns situated at a distance of <2 km from installations. This analysis was repeated for each of the 24 industrial groups. RR and their 95% credible intervals (95% CIs) were estimated on the basis of a Poisson conditional autoregressive Bayesian model with explanatory variables. Integrated nested Laplace approximations were used as a Bayesian inference tool. Analysis showed statistically significant RRs in both sexes in the vicinity of 7 of the 24 industrial groups studied (RR, 95% CI), namely, biocide facilities (2.595, 1.459-4.621), ship-building (2.321, 1.379-3.918), glass and mineral fibre production (1.667, 1.041-2.665), non-hazardous waste treatment (1.737, 1.077-2.799), galvanising (1.637, 1.139-2.347), organic chemical plants (1.386, 1.075-1.782) and the food and beverage sector (1.255, 1.006-1.562). In the proximity of sources pertaining to the biocide, organic chemical and galvanising sectors, the risk was seen to be rising among men and women, a finding that could indicate airborne environmental exposure. These results support that residing in the vicinity of IPPC-registered industries that

  3. Pleural solitary fibrous tumor complicated with autoimmune hemolytic anemia.

    PubMed

    Takahashi, Hiroshi; Ohkawara, Hiroshi; Ikeda, Kazuhiko; Harada-Shirado, Kayo; Furukawa, Miki; Sukegawa, Masumi; Shichishima-Nakamura, Akiko; Noji, Hideyoshi; Wakamatsu, Saho; Tasaki, Kazuhiro; Suzuki, Hiroyuki; Ogawa, Kazuei; Takeishi, Yasuchika

    2014-01-01

    We herein report a 74-year-old woman who presented with autoimmune hemolytic anemia (AIHA) associated with pleural solitary fibrous tumor (SFT). Her AIHA was initially treated with 1 mg/kg daily of oral prednisolone (PSL) for 2 months, which had a limited effect. However, after surgical tumor resection, the patient showed remarkable improvement of AIHA with normalizations of serum lactate dehydrogenase and bilirubin levels, and we were able to rapidly reduce the PSL dosage. This is the first description of a case of AIHA caused by SFT.

  4. [Role of procalcitonin rapid test in the differential diagnosis of uninfected and infected forms of acute pancreatitis].

    PubMed

    Makay, Roland; Issekutz, Akos; Banga, Péter; Belágyi, Tibor; Oláh, Attila

    2003-02-01

    We analysed the clinical value of the procalcitonin quick test (PCT-Q; BRAHMS Diagnostica, GmbH, Berlin) in infected pancreatic necrosis verified by guided fine-needle aspiration (FNA). In a prospective, controlled study the results of 24 patients were evaluated during 2001. PCT-Q test was performed in patients with necrosis verified on CT scan and/or septic symptoms. If PCT-Q test was positive or septic complication (infected necrosis or abscess) developed CT or US guided fine-needle aspiration was performed with Gram staining and bacterial culture of the sample. Positive FNA result was indication for surgery with repeated staining and bacterial culture of the surgical specimen. Septic complications of pancreatic origin developed in 12 patients. Comparing the results fine-needle aspiration was more authentic with a sensitivity of 92% and a specificity of 100%, while the sensitivity of the PCT-Q test remained 75% and its specificity 83%. Comparing abscess and infected necrosis, significantly higher procalcitonin values were detected in patients with necrosis. These results show that PCT-Q test can be a possible non-invasive method besides fine-needle aspiration. Elevated levels of procalcitonin (higher than 2 ng/ml) clearly suggest infection of the necrosis, while lower values do not exclude the possibility of local septic progression.

  5. [Chest drainage combined with intracavitary therapy in neoplastic pleural effusion: comparison of three different protocols].

    PubMed

    D'Angelo, P; Sacco, R; Romessis, M; Mucilli, F

    1993-07-01

    Twenty-eight patients with malignant pleural effusion observed in a two year period were treated with intrapleural instillation of different substances: Tetracycline, Corynebacterium parvum and Beta-Interferon. Different results were observed: complete responsiveness (no recurrence of pleural effusion within three months); partial responsiveness (recurrence of moderate pleural effusion within one month after drainage removal); insufficient responsiveness (recurrence of massive effusion within one month). Among patients treated with Tetracycline seven complete, five partial and one insufficient responses were observed. Instillation of Corynebacterium parvum allowed two complete, two partial and three insufficient responses. Finally, in the group treated with Beta-Interferon complete responsiveness was obtained in just one patient, partial responsiveness in three, while the treatment was insufficient in the last two. These results suggest pleural drainage is the best treatment in patients with malignant pleural effusion, however, the association of Tetracycline instillation allows better results. PMID:8398623

  6. Clinical Applications of Procalcitonin in Pediatrics: An Advanced Biomarker for Inflammation and Infection—Can It Also Be Used in Trauma?

    PubMed Central

    Loscalzo, Steven M.; Singh, Sabina; Weiner, Evan; Syriopoulou, Vassiliki; Theocharis, Stamatios; Chrousos, Georgios

    2014-01-01

    Background. Procalcitonin is a small molecular peptide that has gained increased support as an adjunct diagnostic marker of infection in the adult population; the concordant body of evidence for the use of procalcitonin in pediatric populations is far less complete. Objectives. Our objective is to review the current evidence supporting the utilization of procalcitonin in children in a variety of clinical scenarios including SIRS, sepsis, burns, and trauma and to identify existing knowledge gaps. Methods. A thorough review of the literature was performed utilizing PubMed. We focused on using meta-analysis from adult populations to review current practices in interpretation and methodology and find concordant pediatric studies to determine if the same applications are validated in pediatric populations. Results. Current evidence supports the usage of procalcitonin as both a sensitive and a specific marker for the differentiation of systemic inflammatory response syndrome from sepsis in pediatrics with increased diagnostic accuracy compared to commonly used biomarkers including complete blood counts and C-reactive protein. Conclusions. Although the body of evidence is limited, initial observations suggest that procalcitonin can be used in pediatric trauma and burn patients as both a prognostic and a diagnostic marker, aiding in the identification of infection in patients with extensive underlying inflammation. PMID:27355024

  7. bcl-2 expression in pleural and extrapleural solitary fibrous tumours.

    PubMed

    Chilosi, M; Facchettti, F; Dei Tos, A P; Lestani, M; Morassi, M L; Martignoni, G; Sorio, C; Benedetti, A; Morelli, L; Doglioni, C; Barberis, M; Menestrina, F; Viale, G

    1997-04-01

    This study evaluated the immunoreactivity for bcl-2, a molecule involved in the control of programmed cell death, in cases of pleural (14) and extrapleural (2) solitary fibrous tumour (SFT), malignant mesotheliomas of different histological types, and a variety of extrapleural CD34-positive and CD34-negative spindle-cell tumours. In all SFTs, strong and diffuse immunostaining was demonstrated with anti-bel-2 antibody, sharply contrasting with the complete lack of staining observed in all mesotheliomas. The specificity of immunodetection of bcl-2 in SFT was confirmed by immunoblot analysis, showing a band consistent with the bcl-2 protein. At extrapleural locations, strong bcl-2 immunoreactivity was observed in Schwannoma (2/3 cases), synovial sarcoma (4/4 cases), and all cases of CD34-positive gastrointestinal stromal tumour (GIST; 10/10 cases). Most sarcomas were bcl-2-negative. Lack of bcl-2 expression was demonstrated in tumours which can pose problems in the differential diagnosis of SFT and can exhibit haemangiopericytoma-like features, including haemangiopericytoma (3 cases), dermatofibrosarcoma protuberans (16 cases), and deep-seated fibrous histiocytoma (3 cases). The constitutive expression of bcl-2 in SFT widens the spectrum of available markers for these tumours, providing a useful adjunct to their differential diagnosis in difficult cases at pleural and extrapleural sites, and contributing to the understanding of their histogenesis and molecular pathogenesis.

  8. Mixed lubrication after rewetting of blotted pleural mesothelium.

    PubMed

    Bodega, Francesca; Sironi, Chiara; Porta, Cristina; Pecchiari, Matteo; Zocchi, Luciano; Agostoni, Emilio

    2013-01-15

    Coefficient of kinetic friction (μ) of pleural mesothelium blotted with filter paper, and rewetted with Ringer solution markedly increases; this increase is removed if a sufficient amount of sialomucin or hyaluronan is added to Ringer (Bodega et al., 2012. Respiratory Physiology and Neurobiology 180, 34-39). In this research we found that μ of pleural mesothelium blotted, rewetted, and sliding at physiological velocities and loads, decreased with increase of velocity, mainly at low velocities. Despite this decrease, μ at highest velocity was still double that before blotting. With small concentration of sialomucin or hyaluronan μ was markedly smaller at each velocity, decreased less with increase of velocity, and at highest velocity approached preblotting value. These findings indicate a regime of mixed lubrication in post-blotting Ringer, at variance with boundary lubrication occurring before blotting or postblotting with sufficient macromolecule addition. Greater roughness of mesothelial surface, caused by blotting, likely induces zones of elastohydrodynamic lubrication, which increase with velocity, while contact area decreases.

  9. Patient evaluation for rapid pleurodesis of malignant pleural effusions

    PubMed Central

    Krochmal, Rebecca; Reddy, Chakravarthy; Yarmus, Lonny; Desai, Neeraj R.; Feller-Kopman, David

    2016-01-01

    Background Malignant pleural effusions (MPEs) represent advanced stage disease with potentially significant patient discomfort due to dyspnea. Palliative management options include repetitive thoracenteses, placement of a tunneled pleural catheter (TPC), chemical pleurodesis, or some combination of these procedures. The rapid pleurodesis procedure combines thoracoscopic talc pleurodesis and insertion of a TPC at the same time with the goals of reducing both the length of hospitalization and the duration of catheter use. The rapid pleurodesis procedure has previously been described to achieve both of these goals in a pilot study of 30 patients with fully expandable lungs. Both symptoms of dyspnea and quality of life improved with few complications. Additional data on procedural effectiveness is needed to optimize patient selection for this procedure. Methods We performed a retrospective analysis of patients who had undergone rapid pleurodesis protocol at two academic institutions over a 40-month period. Data was collected and analyzed on time to removal of the TPC, chemotherapy, malignancy type, complications, age, and catheter occlusion. Results A total of 29 patients underwent the rapid pleurodesis protocol with a median hospital length of stay of 2 days. Total length of hospitalization was not significantly different between patients with and without primary lung cancer. Median duration of the indwelling TPC was 10 days. Patients with primary lung cancer and those actively or recently undergoing chemotherapy maintained the catheter longer than their counterparts. Conclusions The rapid pleurodesis protocol should be considered a viable treatment option for select patients with symptomatic recurrent MPEs undergoing chemical pleurodesis. PMID:27747006

  10. Real-time treatment feedback guidance of Pleural PDT

    NASA Astrophysics Data System (ADS)

    Zhu, Timothy C.; Kim, Michele M.; Liang, Xing; Liu, Baochang; Meo, Julia L.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles; Cengel, Keith; Friedberg, Joseph

    2013-03-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma with remarkable results. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have improved the GUI of the light dose calculation engine to provide real-time light fluence distribution suitable for guiding the surgery to delivery light more uniformly. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings using both direct and scatter light models. An improved measurement device is developed to automatically acquire laser position for the point source. Comparison of the effects of the guidance is presented in phantom study.

  11. Fatal cases of Staphylococcus aureus pleural empyema in infants.

    PubMed

    Rougemont, Anne-Laure; Buteau, Chantal; Ovetchkine, Philippe; Bergeron, Cybèle; Fournet, Jean-Christophe; Bouron-Dal Soglio, Dorothée

    2009-01-01

    Community-associated infections and especially pleural empyema due to Staphylococcus aureus are increasing worldwide. The virulence of staphylococcal strains is notably determined by different toxin expressing-genes, such as the Panton-Valentine leukocidin (PVL) gene found in S. aureus isolates obtained from pediatric necrotizing pneumonia samples. We describe 2 similar cases of infants with severe respiratory distress and death after an upper respiratory tract infection, having occurred in the same urban area during the same winter time. Necropsies performed between November 2006 and March 2007 revealed bronchopneumonia and an important pleural empyema, justifying the review of clinical charts and laboratory exams. A methicillin-sensitive S. aureus (MSSA) isolate carrying the PVL gene was identified in both cases. We have subsequently cared for an additional case in the same time interval with sudden death and similar pathological findings. No positive microbiological results were obtained, a negative finding possibly related to a 5-day antibiotics regimen. This report describes the pathological features of these cases and stresses the need to recognize PVL-positive S. aureus infections in young children. Finally, we believe that all lethal infections due to PVL-positive S. aureus, independently of the methicillin resistance profile, deserve a mandatory report to the provincial public health authorities. PMID:19192951

  12. Pleurodesis in the treatment of pneumothorax and pleural effusion.

    PubMed

    Suárez, P M Rodríguez; Gilart, J L Freixinet

    2013-06-01

    Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and air, respectively. The objectives are to alleviate symptoms (dyspnea, pain and cough), decrease prolonged air leak, avoid recurrence and improve quality of life. Chemical pleurodesis utilizes chemical irritants. The most common of these is "talc" because of its efficiency and its success in lowering the rate of recurrence. Its main indication is in the palliative treatment of malignant pleural effusion. Other substances less frequently used because they are rarely used currently or under study are cytostatics, antibiotics, antiseptics and autologous blood. Surgical pleurodesis with mechanical abrasion by videothoracoscopy is indicated primarily in the treatment of spontaneous pneumothorax because it is highly efficient, easy to carry out, and has low morbidity when compared to pleurectomy. Using pleurodesis in benign effusion is highly controversial. Its principal indications are hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment. Plasma determinations of systemic inflammatory markers and thoracic ultrasound studies can evaluate the efficacy of pleurodesis. We do not recommend the use of non-steroidal anti-inflammatory drugs in the postoperative period to avoid the possibility of interfering with hemostasis or the formation of adherences.

  13. Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial

    PubMed Central

    Schuetz, Philipp; Christ-Crain, Mirjam; Wolbers, Marcel; Schild, Ursula; Thomann, Robert; Falconnier, Claudine; Widmer, Isabelle; Neidert, Stefanie; Blum, Claudine A; Schönenberger, Ronald; Henzen, Christoph; Bregenzer, Thomas; Hoess, Claus; Krause, Martin; Bucher, Heiner C; Zimmerli, Werner; Müller, Beat

    2007-01-01

    Background: Lower respiratory tract infections like acute bronchitis, exacerbated chronic obstructive pulmonary disease and community-acquired pneumonia are often unnecessarily treated with antibiotics, mainly because of physicians' difficulties to distinguish viral from bacterial cause and to estimate disease-severity. The goal of this trial is to compare medical outcomes, use of antibiotics and hospital resources in a strategy based on enforced evidence-based guidelines versus procalcitonin guided antibiotic therapy in patients with lower respiratory tract infections. Methods and design: We describe a prospective randomized controlled non-inferiority trial with an open intervention. We aim to randomize over a fixed recruitment period of 18 months a minimal number of 1002 patients from 6 hospitals in Switzerland. Patients must be >18 years of age with a lower respiratory tract infections <28 days of duration. Patients with no informed consent, not fluent in German, a previous hospital stay within 14 days, severe immunosuppression or chronic infection, intravenous drug use or a terminal condition are excluded. Randomization to either guidelines-enforced management or procalcitonin-guided antibiotic therapy is stratified by centre and type of lower respiratory tract infections. During hospitalization, all patients are reassessed at days 3, 5, 7 and at the day of discharge. After 30 and 180 days, structured phone interviews by blinded medical students are conducted. Depending on the randomization allocation, initiation and discontinuation of antibiotics is encouraged or discouraged based on evidence-based guidelines or procalcitonin cut off ranges, respectively. The primary endpoint is the risk of combined disease-specific failure after 30 days. Secondary outcomes are antibiotic exposure, side effects from antibiotics, rate and duration of hospitalization, time to clinical stability, disease activity scores and cost effectiveness. The study hypothesis is that

  14. Pleural effusion adenosine deaminase: a candidate biomarker to discriminate between Gram-negative and Gram-positive bacterial infections of the pleural space

    PubMed Central

    Li, Ruolin; Wang, Junli; Wang, Xinfeng; Wang, Maoshui

    2016-01-01

    OBJECTIVES: Delay in the treatment of pleural infection may contribute to its high mortality. In this retrospective study, we aimed to evaluate the diagnostic accuracy of pleural adenosine deaminase in discrimination between Gram-negative and Gram-positive bacterial infections of the pleural space prior to selecting antibiotics. METHODS: A total of 76 patients were enrolled and grouped into subgroups according to Gram staining: 1) patients with Gram-negative bacterial infections, aged 53.2±18.6 years old, of whom 44.7% had empyemas and 2) patients with Gram-positive bacterial infections, aged 53.5±21.5 years old, of whom 63.1% had empyemas. The pleural effusion was sampled by thoracocentesis and then sent for adenosine deaminase testing, biochemical testing and microbiological culture. The Mann-Whitney U test was used to examine the differences in adenosine deaminase levels between the groups. Correlations between adenosine deaminase and specified variables were also quantified using Spearman’s correlation coefficient. Moreover, receiver operator characteristic analysis was performed to evaluate the diagnostic accuracy of pleural effusion adenosine deaminase. RESULTS: Mean pleural adenosine deaminase levels differed significantly between Gram-negative and Gram-positive bacterial infections of the pleural space (191.8±32.1 U/L vs 81.0±16.9 U/L, p<0.01). The area under the receiver operator characteristic curve was 0.689 (95% confidence interval: 0.570, 0.792, p<0.01) at the cutoff value of 86 U/L. Additionally, pleural adenosine deaminase had a sensitivity of 63.2% (46.0-78.2%); a specificity of 73.7% (56.9-86.6%); positive and negative likelihood ratios of 2.18 and 0.50, respectively; and positive and negative predictive values of 70.6% and 66.7%, respectively. CONCLUSIONS: Pleural effusion adenosine deaminase is a helpful alternative biomarker for early and quick discrimination of Gram-negative from Gram-positive bacterial infections of the pleural space

  15. Procalcitonin Test

    MedlinePlus

    ... tests: C-Reactive Protein , Complete Blood Count , Blood Culture , CSF Analysis ... test is relatively new, but its utilization is increasing. Recent studies have shown that it has promise in helping ...

  16. [MULTIMODAL APPROACH IN THE TREATMENT OF PATIENTS WITH MALIGNANT PLEURAL LESIONS].

    PubMed

    Levchenko, E V; Mamontov, O Yu; Senchik, K Yu; Barchuk, A S; Gelfond, M L

    2015-01-01

    The study includes data on 54 patients with pleural malignant lesions (39 with metastatic pleural malignant tumors and 15 with pleural malignant mesothelioma) received treatment using a multimodal approach: maximum cytoreduction, intraoperative photodynamic therapy and hyperthermic chemoperfusion of pleural cavity. A control group of patients with malignant pleural mesothelioma consisted of 21 patients who had undergone only conservative treatment. It was found out that the use two-thoracotomy surgical approach had advantages over standard thoracotomy across IV intercostal space. The use of multimodal treatment was accompanied by relatively low (1.85%) postoperative mortality on the background of a relatively high number (79.6%) of postoperative complications, easily cured in the early postoperative period. The use of multimodal therapy in treatment for metastatic pleural malignant lesions was accompanied by a median of disease-free survival of 11 months and a median of overall survival of 23 months. The proposed multimodal treatment compared with conservative methods of therapy improved disease-free (12 months vs. 7.5 months) and overall (18.8 months vs. 10.2 months) survival. Thus the use of a multimodal approach in treatment for pleural malignant lesions is relatively safe but requires further study. PMID:26242152

  17. Automated anatomical description of pleural thickening towards improvement of its computer-assisted diagnosis

    NASA Astrophysics Data System (ADS)

    Chaisaowong, Kraisorn; Jiang, Mingze; Faltin, Peter; Merhof, Dorit; Eisenhawer, Christian; Gube, Monika; Kraus, Thomas

    2016-03-01

    Pleural thickenings are caused by asbestos exposure and may evolve into malignant pleural mesothelioma. An early diagnosis plays a key role towards an early treatment and an increased survival rate. Today, pleural thickenings are detected by visual inspection of CT data, which is time-consuming and underlies the physician's subjective judgment. A computer-assisted diagnosis system to automatically assess pleural thickenings has been developed, which includes not only a quantitative assessment with respect to size and location, but also enhances this information with an anatomical description, i.e. lung side (left, right), part of pleura (pars costalis, mediastinalis, diaphragmatica, spinalis), as well as vertical (upper, middle, lower) and horizontal (ventral, dorsal) position. For this purpose, a 3D anatomical model of the lung surface has been manually constructed as a 3D atlas. Three registration sub-steps including rigid, affine, and nonrigid registration align the input patient lung to the 3D anatomical atlas model of the lung surface. Finally, each detected pleural thickening is assigned a set of labels describing its anatomical properties. Through this added information, an enhancement to the existing computer-assisted diagnosis system is presented in order to assure a higher precision and reproducible assessment of pleural thickenings, aiming at the diagnosis of the pleural mesothelioma in its early stage.

  18. A review of uncommon cytopathologic diagnoses of pleural effusions from a chest diseases center in Turkey

    PubMed Central

    Cakir, Ebru; Demirag, Funda; Aydin, Mehtap; Erdogan, Yurdanur

    2011-01-01

    Background: After pneumonia, cancer involving the pleura is the leading cause of exudative pleural effusion. Cytologic examination of pleural effusions is an important initial step in management of malignant effusions. The aim of this study is to evaluate the spectrum of uncommon malignant pleural effusions in a chest disease center in Turkey. Materials and Methods: A retrospective study of samples of pleural effusions submitted to Ataturk Chest Diseases and Chest Surgery Education and Research Hospital Department of Pathology between March 2005 and November 2008 was performed. Results: Out of a total of 4684 samples reviewed 364 (7.8%) were positive for cancer cells. Of the malignant pleural effusions 295 (81%) were classified as adenocarcinoma or carcinoma not otherwise specified (NOS). Pleural effusion specimens revealing a diagnosis other than adenocarcinoma/carcinoma NOS were: 32 (8.8%) malignant mesotheliomas, 14 (3.8%) small cell carcinomas, 13 (3.5%) hematolymphoid malignancies and 10 (2.7%) squamous cell carcinoma. Hematolymphoid malignancies included non- Hodgkin lymphoma (diffuse B large cell lymphoma, mantle cell lymphoma), multiple myeloma, chronic myeloid leukemia, and acute myeloid leukemia. Conclusions: Despite that adenocarcinoma is the most common cause of malignant pleural effusions, there is a significant number of hematological and non-hematological uncommon causes of such effusions. Cytopathologists and clinicians must keep in mind these uncommon entities in routine practice for an accurate diagnosis. PMID:21799700

  19. Procalcitonin levels in acute exacerbation of COPD admitted in ICU: a prospective cohort study

    PubMed Central

    Daubin, Cédric; Parienti, Jean-Jacques; Vabret, Astrid; Ramakers, Michel; Fradin, Sabine; Terzi, Nicolas; Freymuth, François; Charbonneau, Pierre; du Cheyron, Damien

    2008-01-01

    Background Antibiotics are recommended for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care units (ICU). Serum procalcitonin (PCT) could be a useful tool for selecting patients with a lower probability of developing bacterial infection, but its measurement has not been investigated in this population. Methods We conducted a single center prospective cohort study in consecutive COPD patients admitted to the ICU for AECOPD between September 2005 and September 2006. Sputum samples or tracheal aspirates were tested for the presence of bacteria and viruses. PCT levels were measured at the time of admittance, six hours, and 24 hours using a sensitive immunoassay. Results Thirty nine AECOPD patients were included, 31 of which (79%) required a ventilator support at admission. The median [25%–75% interquartile range] PCT level, assessed in 35/39 patients, was: 0.096 μg/L [IQR, 0.065 to 0.178] at the time of admission, 0.113 μg/L [IQR, 0.074 to 0.548] at six hours, and 0.137 μg/L [IQR, 0.088 to 0.252] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 μg/L in 14/35 (40%) patients and more than 0.25 μg/L in 10/35 (29%) patients, suggesting low and high probability of bacterial infection, respectively. Five species of bacteria and nine species of viruses were detected in 12/39 (31%) patients. Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 μg/L and three had a PCTmax less than 0.1 μg/L. The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 μg/L. The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 μg/L respectively, P = 0.80). Conclusion The likelihood of bacterial infection is low among COPD patients admitted to ICU for AECOPD (40% with PCT < 0.1 μg/L) suggesting a possible inappropriate use of antibiotics. Further studies are necessary to assess the impact of a procalcitonin

  20. Membranous nephropathy associated with malignant pleural mesothelioma in an adult patient: A case report

    PubMed Central

    Pu, Xinyu; Dou, Yanna; Liu, Dong; Lu, Shan; Quan, Songxia; Zhang, Xiaoxue; Ma, Shuang; Zhao, Zhanzheng

    2016-01-01

    A 23-year-old man presented to our hospital with membranous nephropathy and received a detailed examination, including pleural biopsy, due to a feeling of chest oppression. The result of the pleural biopsy was malignant pleural mesothelioma. However, the patient did not have a history of asbestos or tobacco exposure. A review of the English literature identified only 7 reported cases of concomitant malignant mesothelioma and nephrotic syndrome. Furthermore, among the 7 cases reviewed, 6 had a history of asbestos exposure, 1 had a history of prolonged tobacco exposure and in only 1 case the renal pathology results revealed the presence of membranous nephropathy. PMID:27699035

  1. Membranous nephropathy associated with malignant pleural mesothelioma in an adult patient: A case report

    PubMed Central

    Pu, Xinyu; Dou, Yanna; Liu, Dong; Lu, Shan; Quan, Songxia; Zhang, Xiaoxue; Ma, Shuang; Zhao, Zhanzheng

    2016-01-01

    A 23-year-old man presented to our hospital with membranous nephropathy and received a detailed examination, including pleural biopsy, due to a feeling of chest oppression. The result of the pleural biopsy was malignant pleural mesothelioma. However, the patient did not have a history of asbestos or tobacco exposure. A review of the English literature identified only 7 reported cases of concomitant malignant mesothelioma and nephrotic syndrome. Furthermore, among the 7 cases reviewed, 6 had a history of asbestos exposure, 1 had a history of prolonged tobacco exposure and in only 1 case the renal pathology results revealed the presence of membranous nephropathy.

  2. Significance of Total Protein, Albumin, Globulin, Serum Effusion Albumin Gradient and LDH in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis and Cancer

    PubMed Central

    Sharma, Ashish; Das, Biswajit; Mallick, Ayaz K; Kumar, Amit

    2016-01-01

    Introduction Lung cancer and Pulmonary tuberculosis are two major public health problems associated with significant morbidity and mortality worldwide particularly in low and middle income countries like India. Wrong diagnosis of lung cancer cases as pulmonary tuberculosis in primary health care system delays the onset of anti-cancer chemotherapy as well as initiation of DOTS thus increasing complication and mortality rate in malignancy patients. In this context easy, cost effective diagnostic tool at primary level must be the priority and need of hour. Aim To study and evaluate any significance of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) in serum and pleural effusion secondary to tuberculosis and lung cancer. Materials and Methods A case control study was carried out on patients attending OPD and IPD, Department of Pulmonary Medicine, RMCH. Hundred cases of Tuberculosis effusion, 50 cases of Malignant effusion and 100 age and sex matched apparently healthy controls were taken for correlation of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) and statistically evaluated to find any significance between tuberculosis, lung cancer and control group. Blood and pleural fluid samples were collected and then subjected to assessment of parameters (total protein, albumin, LDH) by using EM360 Autoanalyser and kits were supplied by Transasia diagnostics. Globulin and Serum Effusion Albumin Gradient (SEAG) was calculated mathematically. Statistical Analysis Data is presented as mean ± SD. Comparison of serum and pleural fluid levels (of taken parameters) were done in TB, Lung Cancer and Control groups by ANOVA and students t-test. The p-value <0.05 were considered as statistically significant. Results We found serum-total protein, albumin, globulin to be significantly higher in TB group than lung cancer group but serum LDH was higher in lung cancer group (in all parameters p

  3. Environmental household exposures to asbestos and occurrence of pleural mesothelioma.

    PubMed

    Dodoli, D; Del Nevo, M; Fiumalbi, C; Iaia, T E; Cristaudo, A; Comba, P; Viti, C; Battista, G

    1992-01-01

    We reviewed the certificates of 39,650 deaths which occurred in the period 1975-1988 in Leghorn and of 45,900 in La Spezia (Italy) in the period 1958-1988. In total 262 cases have been recorded as pleural mesothelioma. The main occupational exposures occurred in the shipbuilding industry. Regarding non-occupational exposures to asbestos, 13 cases of mesothelioma were found in women who had washed the work clothes of their relatives at home; we also found other domestic uses of asbestos which were rarely or never discussed previously in the literature: six cases might be explained by the installation of fireproof or non-conductive materials in the domestic environment. These exposures probably are more frequent than realized until now.

  4. Non-coding RNA repertoires in malignant pleural mesothelioma.

    PubMed

    Quinn, Leah; Finn, Stephen P; Cuffe, Sinead; Gray, Steven G

    2015-12-01

    Malignant pleural mesothelioma (MPM) is a rare malignancy, with extremely poor survival rates. There are limited treatment options, with no second line standard of care for those who fail first line chemotherapy. Recent advances have been made to characterise the underlying molecular mechanisms of mesothelioma, in the hope of providing new targets for therapy. With the discovery that non-coding regions of our DNA are more than mere junk, the field of research into non-coding RNAs (ncRNAs) has exploded in recent years. Non-coding RNAs have diverse and important roles in a variety of cellular processes, but are also implicated in malignancy. In the following review, we discuss two types of non-coding RNAs, long non-coding RNAs and microRNAs, in terms of their role in the pathogenesis of MPM and their potential as both biomarkers and as therapeutic targets in this disease. PMID:26791801

  5. Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case.

    PubMed

    Matsuda, Katsuya; Yamaryo, Takeshi; Akazawa, Yuko; Kawakami, Kenji; Nakashima, Masahiro

    2015-11-01

    We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura.

  6. [Pleural mesothelioma: impact of the staging for the therapeutic strategy].

    PubMed

    Greillier, L; Scherpereel, A; Astoul, P

    2007-10-01

    Realistic improvement has been recently done for the treatment of malignant pleural mesothelioma. Besides new findings for the epidemiology of the disease, medico-social impact for patients, the knowledge of biological parameters for diagnosis, prognosis and future therapeutic targets as well, the early diagnosis of the disease mainly based on more extended practice of thoracoscopy allows in association with new imaging techniques a careful staging of the disease and consequently new therapeutic implications. Indeed if new balistic assessment of the disease improves the efficacy of radiotherapy and new combined chemotherapy have shown antitumoral responses, surgical strategy takes part in the armamenterium for this disease and combined with others therapeutic modalities seems to be a raisonnable approach despite the lack of prospective, comparative, randomized study and the drawback of current staging. However, the most important point is the multidisciplinary concertation induced by the management of this disease which represents a "model" in thoracic oncology.

  7. [Malignant pleural mesothelioma in housewives in the province of Catania].

    PubMed

    Proietti, Lidia; Migliore, Marcello; Polosa, Riccardo; Comba, Pietro; Circo, Cristina; Di Maria, Giuseppe U

    2004-01-01

    Our study reports pleural malignant mesothelioma (PMM) in seven female patients. All patients were resident in Catania area (Sicily), the median age was 69.2 years and ranged from 59 to 81 years. They were housewife. Their anamnesis was negative for both direct and indirect previous exposure to asbestos; the partners of all patients were also not exposed to asbestos. The exposure to X-rays was also excluded for these patients. Different pathogenetic mechanisms for the appearance of PMM in these patients can be hypothesized, for example, SV40 infection and genetic susceptibility; a minimal domestic exposure to asbestos can be not excluded. Therefore, further studies in a more large number of subjects are necessary to determine whether one or all of these hypothetic pathogenetic mechanisms are more significant for the develop of PMM.

  8. Castleman Disease: An Unexpected Cause of a Solitary Pleural Mass

    PubMed Central

    Moloney, Fiachra; Twomey, Maria; Hinchion, John; Maher, Michael

    2013-01-01

    Castleman disease (CD) is a rare benign lymphoproliferative disorder, the etiology of which is unclear. Clinically it may manifest as localized disease (unicentric) or disseminated disease (multicentric). CD occurs in the thorax in 70% of cases, abdomen and pelvis in 15%, and in the neck in 10–15% of cases. We present a case of a pleural mass located posteriorly in a paraspinal location, which was discovered incidentally in a 50-year-old man and was subsequently resected followed by an unexpected diagnosis of Castleman disease on histological examination. In this report, we review the clinical and histological findings in a rare presentation of Castleman disease and discuss the findings in this case as part of an overall review of the typical radiological findings seen in Castleman disease. PMID:24106632

  9. Non-coding RNA repertoires in malignant pleural mesothelioma.

    PubMed

    Quinn, Leah; Finn, Stephen P; Cuffe, Sinead; Gray, Steven G

    2015-12-01

    Malignant pleural mesothelioma (MPM) is a rare malignancy, with extremely poor survival rates. There are limited treatment options, with no second line standard of care for those who fail first line chemotherapy. Recent advances have been made to characterise the underlying molecular mechanisms of mesothelioma, in the hope of providing new targets for therapy. With the discovery that non-coding regions of our DNA are more than mere junk, the field of research into non-coding RNAs (ncRNAs) has exploded in recent years. Non-coding RNAs have diverse and important roles in a variety of cellular processes, but are also implicated in malignancy. In the following review, we discuss two types of non-coding RNAs, long non-coding RNAs and microRNAs, in terms of their role in the pathogenesis of MPM and their potential as both biomarkers and as therapeutic targets in this disease.

  10. Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case.

    PubMed

    Matsuda, Katsuya; Yamaryo, Takeshi; Akazawa, Yuko; Kawakami, Kenji; Nakashima, Masahiro

    2015-11-01

    We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura. PMID:26314557

  11. [Horner's syndrome in a patient with diffuse malignant pleural mesothelioma].

    PubMed

    Minami, T; Matsumoto, K; Aizawa, H; Nakano, H; Sugio, K; Nakashima, Y; Hara, N

    1999-04-01

    A 63-year-old man was admitted to our hospital because of left back pain and dysesthesia in his left arm. On physical examination, the patient had ptosis, myosis, and anhydrosis on the left side, suggesting Horner's syndrome. A chest computed tomographic scan disclosed a mass lesion adjoining to the left posterior mediastinum. Although the mass lesion showed a slight decrease in size after the systemic administration of corticosteroids, no further improvement was obtained. Open chest examination revealed extended thickening of the parietal pleura with massive involvement of the upper thoracic sympathetic trunk. The diagnosis was malignant mesothelioma of sarcomatous type. Horner's syndrome is a rare but possible complication in the clinical course of malignant pleural mesothelioma. PMID:10390966

  12. A Total Pleural Covering for Lymphangioleiomyomatosis Prevents Pneumothorax Recurrence

    PubMed Central

    Kurihara, Masatoshi; Mizobuchi, Teruaki; Kataoka, Hideyuki; Sato, Teruhiko; Kumasaka, Toshio; Ebana, Hiroki; Yamanaka, Sumitaka; Endo, Reina; Miyahashira, Sumika; Shinya, Noriko; Seyama, Kuniaki

    2016-01-01

    Background Spontaneous pneumothorax is a major and frequently recurrent complication of lymphangioleiomyomatosis (LAM). Despite the customary use of pleurodesis to manage pnenumothorax, the recurrence rate remains high, and accompanying pleural adhesions cause serious bleeding during subsequent lung transplantation. Therefore, we have developed a technique of total pleural covering (TPC) for LAM to wrap the entire visceral pleura with sheets of oxidized regenerated cellulose (ORC) mesh, thereby reinforcing the affected visceral pleura and preventing recurrence. Methods Since January 2003, TPC has been applied during video-assisted thoracoscopic surgery for the treatment of LAM. The medical records of LAM patients who had TPC since that time and until August 2014 are reviewed. Results TPC was performed in 43 LAM patients (54 hemithoraces), 11 of whom required TPC bilaterally. Pneumothorax recurred in 14 hemithoraces (25.9%) from 11 patients (25.6%) after TPC. Kaplan-Meier estimates of recurrence-free hemithorax were 80.8% at 2.5 years, 71.7% at 5 years, 71.7% at 7.5 years, and 61.4% at 9 years. The recurrence-free probability was significantly better when 10 or more sheets of ORC mesh were utilized for TPC (P = 0.0018). TPC significantly reduced the frequency of pneumothorax: 0.544 ± 0.606 episode/month (mean ± SD) before TPC vs. 0.008 ± 0.019 after TPC (P<0.0001). Grade IIIa postoperative complications were found in 13 TPC surgeries (24.1%). Conclusions TPC successfully prevented the recurrence of pneumothorax in LAM, was minimally invasive and rarely caused restrictive ventilatory impairment. PMID:27658250

  13. A molecular epidemiology case control study on pleural malignant mesothelioma.

    PubMed

    Bolognesi, Claudia; Martini, Fernanda; Tognon, Mauro; Filiberti, Rosa; Neri, Monica; Perrone, Emanuela; Landini, Eleonora; Canessa, Paolo A; Ivaldi, Gian Paolo; Betta, Pietro; Mutti, Luciano; Puntoni, Riccardo

    2005-07-01

    Pleural malignant mesothelioma is an uncommon neoplasm usually associated with asbestos exposure. The increasing incidence of malignant mesothelioma cases involving individuals with low levels of asbestos exposure suggests a complex carcinogenetic process with the involvement of other cofactors. Cytogenetic studies revealed the complexity of the genetic changes involved in this neoplasm reflecting the accumulation of genomic damage. One of the most used methodologies for assessing genomic damage is the cytokinesis-blocked micronucleus test applied in peripheral blood lymphocytes (PBL). This approach allows the detection of chromosomal alterations expressed in binucleated cells after nuclear division in vitro. This marker could provide a tool for assessing genetically determined constitutional differences in chromosomal instability. A biomonitoring study was carried out to evaluate the micronuclei frequency in PBLs of patients with pleural malignant mesothelioma with respect to lung cancer, healthy, and risk controls as a marker of cancer susceptibility in correlation with the presence of SV40. A significant increased micronuclei frequency was observed in patients with malignant mesothelioma in comparison with all the other groups, the mean micronuclei frequency was double in patients with malignant mesothelioma compared with healthy controls, risk controls, and patients with lung adenocarcinoma (median 11.4 binucleated cells with micronuclei/1,000 binucleated cells versus 6.2, 6.1, and 5.1, respectively). Our data indicate that human T lymphocyte samples carry DNA sequences coding for SV40 large T antigen at low prevalence, both in cancer cases and controls. Evidence of cytogenetic damage revealed as micronuclei frequency in mesothelioma cancer patients could be related to exogenous and endogenous cofactors besides asbestos exposure.

  14. Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study

    PubMed Central

    2010-01-01

    Introduction This prospective study investigated the predictive value of procalcitonin (PCT) for survival in 242 adult patients with severe sepsis and septic shock treated in intensive care. Methods PCT was analyzed from blood samples of all patients at baseline, and 155 patients 72 hours later. Results The median PCT serum concentration on day 0 was 5.0 ng/ml (interquartile range (IQR) 1.0 and 20.1 ng/ml) and 1.3 ng/ml (IQR 0.5 and 5.8 ng/ml) 72 hours later. Hospital mortality was 25.6% (62/242). Median PCT concentrations in patients with community-acquired infections were higher than with nosocomial infections (P = 0.001). Blood cultures were positive in 28.5% of patients (n = 69), and severe sepsis with positive blood cultures was associated with higher PCT levels than with negative cultures (P = < 0.001). Patients with septic shock had higher PCT concentrations than patients without (P = 0.02). PCT concentrations did not differ between hospital survivors and nonsurvivors (P = 0.64 and P = 0.99, respectively), but mortality was lower in patients whose PCT concentration decreased > 50% (by 72 hours) compared to those with a < 50% decrease (12.2% vs. 29.8%, P = 0.007). Conclusions PCT concentrations were higher in more severe forms of severe sepsis, but a substantial concentration decrease was more important for survival than absolute values. PMID:21078153

  15. Procalcitonin as diagnostic marker of infection in solid tumors patients with fever.

    PubMed

    Vincenzi, B; Fioroni, I; Pantano, F; Angeletti, S; Dicuonzo, G; Zoccoli, A; Santini, D; Tonini, G

    2016-01-01

    In oncologic patients fever is a non-specific clinical marker of different clinical settings. Procalcitonin (PCT) seems to be the most promising infection marker. We aimed to define the potential role of PCT as an earlier diagnostic marker in patients with fever and solid tumor. This retrospective study enrolled 431 patients. All of them performed hemoculture (HE) and basal PCT assessment (reference laboratory cut-off: ≤0.5 or >0.5 ng/dL) before starting antibiotic therapy. Gram positive (G+), negative (G-) or Fungi infection were detected. A statistically significant difference in PCT levels between patients with positive and negative HE was observed (P < 0.0001). Moreover comparing PCT values in patients with positive and negative HE, we obtain in the positive HE subpopulation an AUC of 0.7 and a cut-off of 1.52 ng/dL reached high sensitivity (61.6%) and specificity (70.1%). Using this last cut-off, instead of the normal reference value, we achieve a risk reduction to overestimate an infection status of 23.4%. We support the clinic usefulness of serum PCT dosage in febrile advanced solid tumor patients. A PCT cut-off of 1.52 ng/dL could be helpful in the management of the antibiotic therapy preventing delays of oncologic treatments. PMID:27312877

  16. [Diagnostic value of the procalcitonine test in purulent-septic complications of chest traumas].

    PubMed

    Vadachkoriia, V K; Gogishvili, Sh G; Shapatava, K K

    2007-04-01

    The aim of the present work was to assess the value of the semi-quantitative procalcitonine test (PCT) in diagnosis of purulent-septic complications of chest traumas, efficacy of the therapy carried out, and outcome prognosis. For this, 71 patients with chest traumas were enrolled in the study. Concentrations of PCT were assessed in dynamics using an immunochromatographic, semi-quantitative quick test. Semi-quantitative quick PCT test is highly sensitive diagnostic marker that can be used for the assessment of a chest trauma, infectious-septic complication severity, and efficiency of the therapy indicated. Thus, it can be successfully used for monitoring trauma therapy. PCT sensitivity during first 12 hrs of infectious-septic complication development is 2-3-times higher than that of routine methods for laboratory diagnostics, and even more sensitive that IL-6 and CRT, when we are dealing with combined chest traumas. PCT concentration increase is 4-times more frequent in gram-positive bacterial processes than in gram-negative ones. This has to be taken into account, when appropriate antibacterial treatment is selected for restricted infectious-septic complications. PMID:17525495

  17. Procalcitonin implication in renal cell apoptosis induced by acute pyelonephritis in children

    PubMed Central

    Belhadj-Tahar, Hafid; Coulais, Yvon; Tafani, Mathieu; Bouissou, François

    2008-01-01

    The aim of this biomedical trial was to clarify the physiological role of procalcitonin (PCT) in renal parenchyma apoptosis and fibrosis caused by acute childhood pyelonephritis. This prospective study enrolled 183 children. All children were treated with bi-therapy according to the French consensus on acute pyelonephritis treatment dated November 16, 1990: intra-vascular administration of ceftriaxone 50 mg/kg/day and netromicine 7 mg/kg/day during the first 48 hours, followed by specific antibiotherapy suited to antibiogram. On admission, PCT, C-reactive protein, and phospholipase A2 were quantified in serum. Scintigraphy monitoring with 99mTc-DMSA was performed on day 4 and 9 months later, in the presence of persistent abnormalities. On day 4, 78% presented renal parenchyma alterations and 30% renal fibrosis 9 months after admission. Paradoxically, PCT level was significantly lower in the presence of renal fibrosis due to cell apoptosis (4.19 vs 7.59 μgL−1). A significant increase in PCT indicated favorable progress (recovery 7.55 vs aggravation 3.34) and no difference between recovery and improvement. This result suggests the protective effect of PCT against apoptosis by nitric oxide down-regulation. PMID:21694876

  18. Serum C-Reactive Protein and Procalcitonin Kinetics in Patients Undergoing Elective Total Hip Arthroplasty

    PubMed Central

    Battistelli, Sandra; Fortina, Mattia; Carta, Serafino; Guerranti, Roberto; Nobile, Francesco; Ferrata, Paolo

    2014-01-01

    Background. The sensitivity and the specificity of different methods to detect periprosthetic infection have been questioned. The current study aimed to investigate the kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in patients undergoing uncomplicated elective total hip arthroplasty (THA), to provide a better interpretation of their levels in noninfectious inflammatory reaction. Methods. A total of 51 patients were included. Serum CRP and PCT concentrations were obtained before surgery, on the 1st, 3rd, and 7th postoperative days and after discharge on the 14th and 30th days and at 2 years. Results. Both markers were confirmed to increase after surgery. The serum CRP showed a marked increase on the 3rd postoperative day while the peak of serum PCT was earlier, even if much lower, on the first day. Then, they declined slowly approaching the baseline values by the second postoperative week. PCT mean values never exceed concentrations typically related to bacterial infections. Conclusions. CRP is very sensitive to inflammation. It could be the routine screening test in the follow-up of THA orthopaedic patients, but it should be complemented by PCT when there is the clinical suspicion of periprosthetic infection. PMID:24877114

  19. Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia

    PubMed Central

    Oksuz, Lutfiye; Somer, Ayper; Salman, Nuran; Erk, Osman; Gurler, Nezahat

    2014-01-01

    Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman’s rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study. PMID:25763049

  20. [Procalcitonin rapid test in surgical patients treated in the intensive care unit].

    PubMed

    Pinkola, K; Darvas, K

    2001-12-01

    Procalcitonin test (PCT) has been proposed to check severity of generalized infections or sepsis. The authors measured the PCT values with PCT-Q quick test (BRAHMS DIAGNOSTICA GmbH, Berlin) at 14 surgical patients treated in their intensive care unit (7 sepsis, 4 peritonitis, 2 localized pancreatic abscess, 1 postoperative fever). At 3 septic patients (2 pancreatitis, 1 intestinal necrosis) they measured the PCT levels repeatedly during treatment. In 2 patients with localized pancreatic abscess and in 1 patient with postoperative fever without evidence of infection the PCT levels were low (< 0.5 ng/ml). At 4 patients with peritonitis following gastric or colon perforation the PCT levels were highly elevated (> 10 ng/ml). At 7 patients with severe sepsis the PCT values were high (> 2 ng/ml), except for 1 patient with intestinal necrosis. At this patient the PCT levels were repeatedly low. In 2 septic patients with pancreatitis elevated PCT levels indicated the need for surgery. In most patients PCT was a good indicator of generalized infections. PCT levels measured repeatedly in sepsis were lower than in patients with peritonitis.

  1. Multicenter evaluation of a new immunoassay for procalcitonin measurement on the Kryptor System.

    PubMed

    Steinbach, Gerald; Rau, Bettina; Debard, Anne-Lise; Javourez, Jean-François; Bienvenu, Jacques; Ponzio, Antonio; Bonfà, Andrea; Hubl, Walter; Demant, Thomas; Külpmann, W R; Buchholz, Jana; Schumann, Gerhard

    2004-04-01

    We compared the manually performed LUMItest procalcitonin (PCT) assay with the newly developed fully mechanized Kryptor PCT assay and determined the essential assay characteristics of this assay. The new Kryptor PCT assay was evaluated according to modified NCCLS EP-10/EP-6 protocols in five different laboratories. Samples from 696 patients were assayed using the original LUMItest PCT assay and the new Kryptor PCT assay. Possible interference by hemoglobin, triglycerides and bilirubin was evaluated by spiking patient plasma with the appropriate substances. The functional assay sensitivity (FAS) was determined by analyzing samples with low PCT concentrations. The FAS of the new Kryptor PCT assay was 0.04 ng/ml and the imprecision within- and between-series below 5% and below 10%, respectively. Within the smallest range of determination, from 0.3 ng/ml to 50 ng/ml, common to the LUMItest PCT assay (x) and the Kryptor PCT assay (y) the values correlated well: y=0.64+0.94x, s.xy=2.78 ng/ml. The performance characteristics of the Kryptor PCT assay are fully compatible with the intended clinical use. The assay allows determination of PCT in a turnaround time (TAT) of about 20 minutes and thus is adequate for STAT analyses.

  2. Reference intervals for procalcitonin and C-reactive protein after major abdominal surgery.

    PubMed

    Lindberg, M; Hole, A; Johnsen, H; Asberg, A; Rydning, A; Myrvold, H E; Bjerve, K S

    2002-01-01

    Procalcitonin (PCT). a new marker proposed as a diagnostic tool for bacterial infections, triggers a systemic-inflammatory reaction in the body (sepsis, septic shock) and has potential use in a wide range of patient settings. To interpret the results from PCT measurements, we depend on reference intervals established from relevant populations. PCT and C-reactive protein (CRP) concentrations were analysed in 47 patients with a normal postoperative course after major abdominal surgery. The mean concentration of PCT declines from the first day and reaches half its initial values on the second day after the operation. whereas the mean concentration of CRP increases in the first 48 h and reaches half its maximum value on the fifth day after the operation. We present a continuous reference interval for plasma PCT and CRP concentrations in the first week following major abdominal surgery. For PCT we also present a graphic display of expected mean and expected upper reference limits predicted from the value measured on the first postoperative day.

  3. Procalcitonin as an early indicator of outcome in sepsis: a prospective observational study.

    PubMed

    Giamarellos-Bourboulis, E J; Tsangaris, I; Kanni, Th; Mouktaroudi, M; Pantelidou, I; Adamis, G; Atmatzidis, S; Chrisofos, M; Evangelopoulou, V; Frantzeskaki, F; Giannopoulos, P; Giannikopoulos, G; Gialvalis, D; Gourgoulis, G M; Kotzampassi, K; Katsifa, K; Kofinas, G; Kontopidou, F; Koratzanis, G; Koulouras, V; Koutsikou, A; Koupetori, M; Kritselis, I; Leonidou, L; Mega, A; Mylona, V; Nikolaou, H; Orfanos, S; Panagopoulos, P; Paramythiotou, E; Papadopoulos, A; Papanikolaou, X; Pavlaki, M; Polychronopoulos, V; Skoutelis, A; Theodotou, A; Vassiliaghou, M; Douzinas, E E; Gogos, C; Armaganidis, A

    2011-01-01

    This study explores the role of procalcitonin (PCT) in predicting the outcome of sepsis. In a prospective multicentre observational investigation, blood was sampled within 24 h of onset of sepsis in 1156 hospitalised patients; 234 were in the intensive care unit (ICU) at the point of presentation of sepsis while 922 were not. PCT was estimated in serum by the ultrasensitive Kryptor assay in a double-blinded fashion. Among patients outside the ICU, mortality was 8% in those with PCT ≤0.12 ng/mL but 19.9% in those with PCT >0.12 ng/mL [P<0.0001, odds ratio (OR) for death: 2.606; 95% confidence interval (CI): 1.553-4.371]. Among patients whose sepsis presented in ICU, mortality was 25.6% in those with PCT ≤0.85 ng/mL but 45.3% in those with PCT >0.85 ng/mL (P=0.002; OR for death: 2.404; 95% CI: 1.385-4.171). It is concluded that PCT cut-off concentrations can contribute to predicting the outcome of sepsis and might be of particular value in identifying patients who would benefit from ICU admission. PMID:21131099

  4. Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

    PubMed

    Becze, Zsolt; Molnár, Zsolt; Fazakas, János

    2015-12-01

    After decades of extensive experimental and clinical research, septic shock and the related multiple organ dysfunction still remain the leading cause of mortality in intensive care units (ICUs) worldwide. Defining sepsis is a difficult task, but what is even more challenging is differentiating infection-induced from non-infection-induced systemic inflammatory response-related multiple organ dysfunction. As conventional signs of infection are often unreliable in intensive care, biomarkers are used, of which one of the most frequently investigated is procalcitonin. Early stabilisation of vital functions via adequate supportive therapy and antibiotic treatment has resulted in substantial improvements in outcome over the last decades. However, there are certain patients who may need extra help, hence modulation of the immune system and the host's response may also be an important therapeutic approach in these situations. Polyclonal intravenous immunoglobulins have been used in critical care for decades. A relatively new potential approach could be attenuation of the overwhelming cytokine storm by specific cytokine adsorbents. Both interventions have been applied in daily practice on a large scale, with firm pathophysiological rationale but weak evidence supported by clinical trials. The purpose of this review is to give an overview on the pathophysiology of sepsis as well as the role and interpretation of biomarkers and their potential use in assisting adjunctive therapies in sepsis in the future.

  5. Procalcitonin and Pentraxin-3: Current biomarkers in inflammation in white coat hypertension.

    PubMed

    Yavuzer, H; Cengiz, M; Yavuzer, S; Rıza Altıparmak, M; Korkmazer, B; Balci, H; Yaldıran, A L; Uzun, H

    2016-07-01

    An association has been described between inflammation and the progression of hypertension (HT) and is shown with several biochemical parameters. Our aim was to examine the distribution of the serum procalcitonin (PCT), pentraxin (PTX)-3 and interleukin (IL)-33 levels and their relationship with carotid intima-media thickness (CIMT) in subjects with white coat HT (WCH), HT and normotension (NT) groups. Thirty-three patients with HT, 33 patients with WCH and 33 healthy subjects were enrolled in this study. PCT, PTX-3 and C-reactive protein (CRP) levels significantly increased in the HT group compared with the NT group. In addition, PCT and CRP levels were significantly higher in the WCH group than in the NT group. CIMT measurements were significantly higher in the WCH and HT groups than in the NT group. In the HT and WCH groups, there were significant positive correlations between PTX-3, PCT and CRP. In the WCH group, PTX-3 and PCT levels were significantly positively correlated with CIMT. PCT had area under the curve value of 0.817 which demonstrates its sufficiency to distinguish WCH from NT individuals. Our results suggest that in subjects with WCH and HT, which are characterized by increased cardiovascular risk, PTX-3 and PCT levels in the HT group and PCT levels in the WCH group are significantly and consistently higher than normotensives. Systemic inflammation moderately occurs in the WCH and HT groups. PCT monitoring may be a useful biomarker in inflammation related to atherosclerosis and early stage HT.

  6. [Amebic colitis and liver abscess complicated by high serum procalcitonin in acute myeloid leukemia].

    PubMed

    Oku, Eijiro; Nomura, Kei; Nakamura, Takayuki; Morishige, Satoshi; Seki, Ritsuko; Imamura, Rie; Hashiguchi, Michitoshi; Osaki, Kouichi; Mizuno, Shinichi; Nagafuji, Koji; Okamura, Takashi

    2012-11-01

    We present a case of amebic colitis and liver abscess complicated by acute myeloid leukemia (AML) with high serum procalcitonin (PCT). A 61-year-old Japanese man seen at our hospital for severe diarrhea and high fever was found to have multiple ulcers in the transverse and sigmoid colon and rectum by colonoscopy and biopsies were conducted. Immature leukocytes with mild anemia and thrombocytopenia were seen in peripheral blood, necessitating bone marrow aspiration and biopsy that yielded a diagnosis of AML (FAB M4Eo). Serum C-reactive protein and PCT were extremely elevated. Blood cultures for bacteria and fungi were negative. Multiple low-density areas in the liver were found in abdominal computed tomography. Histological colon biopsy findings revealed amebic colitis, strongly suggesting amebic liver abscess. Metronidazole treatment was initiated for amebiasis and subsequent standard chemotherapy for AML was followed after fever was lowered. Hematological and cytogenetic CR was maintained with good clinical condition. Few case reports have been published in Japan to date on amebic colitis and liver abscess complicated by AML and no reports have been made on PCT elevation caused by amebiasis. In conclusion, differential diagnosis of amebiasis is necessary in addition to that of bacterial or fungal infection in serum PCT elevation. PMID:23367854

  7. Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis.

    PubMed

    Liu, Dan; Su, Long-Xiang; Guan, Wei; Xiao, Kun; Xie, Li-Xin

    2016-02-01

    This meta-analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English-language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. The Q-test and I(2) index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community-acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98-6.43), particularly in patients with a low CURB-65 score. The commonly used cut-off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.

  8. Ability of procalcitonin to diagnose bacterial infection and bacteria types compared with blood culture findings

    PubMed Central

    Watanabe, Yuji; Oikawa, Nozomi; Hariu, Maya; Fuke, Ryota; Seki, Masafumi

    2016-01-01

    Procalcitonin (PCT) and C-reactive protein serve as biomarkers of infection in patients with sepsis/bacteremia. The present study assessed the clinical characteristics of 280 patients with suspected sepsis who were admitted to Tohoku Medical and Pharmaceutical University Hospital between January 2012 and December 2013. Among the patients, 133 and 147 were positive and negative for PCT, respectively. Patients who were PCT positive were older and more frequently male, had reduced levels of platelets and albumin, and increased levels of aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, and C-reactive protein. Patients who were PCT positive had significantly higher blood culture positivity compared with those who were PCT negative, and the sensitivity and specificity of PCT for detecting positive blood cultures were 74.5% and 59.1%, respectively. Escherichia coli was detected in PCT-positive patients, whereas Staphylococcus epidermidis and Staphylococcus lugdunensis were frequently detected in PCT-negative patients. Levels of PCT were higher in the patients infected with gram-negative rods than those with gram-positive cocci. Furthermore, extended-spectrum β-lactamase (ESBL)-producing bacteria cases showed higher levels of PCT than those of non-ESBL cases. These results suggest that PCT may be a useful biomarker of sepsis, and it might serve as a strong tool to detect patients with severe gram-negative rod bacteremia including ESBL-producing bacteria cases early due to its relative high sensitivity. PMID:27757046

  9. Dual-Quantum-Dots-Labeled Lateral Flow Strip Rapidly Quantifies Procalcitonin and C-reactive Protein

    NASA Astrophysics Data System (ADS)

    Qi, XiaoPing; Huang, YunYe; Lin, ZhongShi; Xu, Liang; Yu, Hao

    2016-03-01

    In the article, a dual-quantum-dots-labeled (dual-QDs-labeled) lateral flow strip (LFS) method was developed for the simultaneous and rapid quantitative detection of procalcitonin (PCT) and C-reactive protein (CRP) in the blood. Two QD-antibody conjugates with different fluorescence emission spectra were produced and sprayed on the LFS to capture PCT and CRP in the blood. Furthermore, a double antibody sandwich method for PCT and, meanwhile, a competitive inhibition method for CRP were employed in the LFS. For PCT and CRP in serum assayed by the dual-QDs-labeled LFS, their detection sensitivities reached 0.1 and 1 ng/mL, respectively, and their linear quantitative detection ranges were from 0.3 to 200 ng/mL and from 50 to 250 μg/mL, respectively. There was little evidence that the PCT and CRP assays would be interfered with each other. The correlations for testing CRP and PCT in clinical samples were 99.75 and 97.02 %, respectively, between the dual-QDs-labeled LFS we developed and commercial methods. The rapid quantification of PCT and CRP on dual-QDs-labeled LFS is of great clinical value to distinguish inflammation, bacterial infection, or viral infection and to provide guidance for the use of antibiotics or other medicines.

  10. Diagnostic accuracy of procalcitonin and presepsin for infectious disease in patients with acute kidney injury.

    PubMed

    Takahashi, Gaku; Shibata, Shigehiro; Fukui, Yasuo; Okamura, Yoshikazu; Inoue, Yoshihiro

    2016-10-01

    Procalcitonin (PCT) and presepsin (PSEP) are sepsis markers, but their diagnostic accuracy may be compromised in acute kidney injury (AKI). We evaluated their diagnostic accuracy in patients with/without AKI. This retrospective study comprised 91 patients with at least one criterion of systematic inflammatory response syndrome. AKI markers plasma neutrophil gelatinase-associated lipocalin (NGAL), plasma cystatin C (CysC), and estimated glomerular filtration rate (eGFR) were measured upon hospital admission and on days 1, 3, 5, and 7. Patients were divided into non-AKI and AKI groups. APACHE II severity scores were determined. PCT and PSEP levels were increased significantly in non-AKI and AKI patients with infection. NGAL, CysC, and eGFR in patients with infection were associated with PCT, PSEP, and APACHE II score, and levels of PCT and PSEP were correlated significantly with disease severity. PCT and PSEP are useful markers of bacterial infections in AKI but different thresholds should be applied. PMID:27489118

  11. Procalcitonin, MR-Proadrenomedullin, and Cytokines Measurement in Sepsis Diagnosis: Advantages from Test Combination

    PubMed Central

    Angeletti, Silvia; Dicuonzo, Giordano; Fioravanti, Marta; De Cesaris, Marina; Fogolari, Marta; Lo Presti, Alessandra; Ciccozzi, Massimo; De Florio, Lucia

    2015-01-01

    Background. Elevated cytokines levels correlate with sepsis severity and mortality but their role in the diagnosis is controversial, whereas Procalcitonin (PCT) has been largely used. Recently, the mid-regional proadrenomedullin (MR-proADM) has been combined with PCT for diagnosis optimization. In this study the combined measurement of PCT, MR-proADM, and cytokines in patients with sepsis was evaluated. Methods. One hundred and four septic patients and 101 controls were enrolled. Receiver operating characteristic (ROC) analysis and multiple logistic regression were used to evaluate applicant markers for sepsis diagnosis. Markers with best Odds Ratio (OR) were combined, and the posttest probability and a composite score were computed. Results. Based upon ROC curves analysis, PCT, MR-proADM, IL-6, IL-10, TNF-α, and MCP-1 were considered applicant for sepsis diagnosis. Among these PCT, MR-proADM , IL-6, and TNF-α showed the best OR. A better posttest probability was found with the combination of PCT with MR-proADM and PCT with IL-6 or TNF-α compared to the single marker. A composite score of PCT, MR-proADM, and TNF-α showed the best ROC curve in the early diagnosis of sepsis. Conclusion. The combination of PCT with other markers should expedite diagnosis and treatment of sepsis optimizing clinical management. PMID:26635427

  12. Procalcitonin as diagnostic marker of infection in solid tumors patients with fever

    PubMed Central

    Vincenzi, B.; Fioroni, I.; Pantano, F.; Angeletti, S.; Dicuonzo, G.; Zoccoli, A.; Santini, D.; Tonini, G.

    2016-01-01

    In oncologic patients fever is a non-specific clinical marker of different clinical settings. Procalcitonin (PCT) seems to be the most promising infection marker. We aimed to define the potential role of PCT as an earlier diagnostic marker in patients with fever and solid tumor. This retrospective study enrolled 431 patients. All of them performed hemoculture (HE) and basal PCT assessment (reference laboratory cut-off: ≤0.5 or >0.5 ng/dL) before starting antibiotic therapy. Gram positive (G+), negative (G−) or Fungi infection were detected. A statistically significant difference in PCT levels between patients with positive and negative HE was observed (P < 0.0001). Moreover comparing PCT values in patients with positive and negative HE, we obtain in the positive HE subpopulation an AUC of 0.7 and a cut-off of 1.52 ng/dL reached high sensitivity (61.6%) and specificity (70.1%). Using this last cut-off, instead of the normal reference value, we achieve a risk reduction to overestimate an infection status of 23.4%. We support the clinic usefulness of serum PCT dosage in febrile advanced solid tumor patients. A PCT cut-off of 1.52 ng/dL could be helpful in the management of the antibiotic therapy preventing delays of oncologic treatments. PMID:27312877

  13. The positive pleural effusion. A retrospective study of cytopathologic diagnoses with autopsy confirmation.

    PubMed

    DiBonito, L; Falconieri, G; Colautti, I; Bonifacio, D; Dudine, S

    1992-01-01

    We performed an investigation focusing on the distribution of tumor types responsible for positive pleural effusions in 143 patients who died of malignancy and underwent autopsy. The principal malignant tumors were lung carcinoma (41 cases, 51.2%) and pleural mesothelioma (23 cases, 28.7%) in males and breast carcinoma (24 cases, 38.2%) and lung carcinoma (13 cases, 20.6%) in females. Histologically, most of the cases belonged to the adenocarcinoma category. The first morphologic diagnosis was a cytologic one in 86 cases (60.1%), especially regarding lung cancer. In breast cancer a positive pleural effusion always preceded recurrent disease with a rapidly progressive course, even a long time after the initial surgery. The results of this study, based on both cytomorphologic features and postmortem data on the tumor sites, may be a useful working framework for the cytologist dealing with a positive pleural effusion.

  14. Radiological study of pleural changes in relation to mesothelioma in Turkey.

    PubMed

    Hillerdal, G; Baris, Y I

    1983-06-01

    In some villages in central Turkey pleural changes occur as a result of environmental exposure to mineral fibres. In most cases the fibre is asbestos but in some cases the non-asbestos fibre erionite, a zeolite, is responsible. The incidence of malignant mesothelioma is much higher in "erionite villages" than in "asbestos villages" despite similar frequencies of pleural changes. In this study chest radiographs from 466 people from asbestos villages, 549 from erionite villages, and 382 controls were compared. The frequency of pleural calcification was about the same in the two groups of villages studied, but the minor fissures were visible to a greater degree in erionite cases. In people from erionite villages "atypical" pleural calcification, due to calcification of the visceral rather than the parietal pleura, was more common. These differences may indicate that the fibres have different lengths and diameters.

  15. [Etiology of pleural effusion based on material from the Hospital of Lung Diseases and Tuberculosis].

    PubMed

    Kolczyński, A

    2001-01-01

    The aim of this study was to show the influence of the changes in incidence of tuberculosis and lung cancer on the etiology of pleural effusion among the patients of the Hospital of Lung Diseases and Tuberculosis. To this end 349 patients with pleural effusion were separated from the total number of 9786 patients treated in years 1990-1999. The most numerous group--180 patients (51.58%)--consisted of the cases of malignant neoplasms, 109 (31.25%)--tuberculosis and 60 (17.17%)--remaining diseases altogether. At the time, the statistically significant increase of the whole number of patients with pleural effusion as well as the increase of patients with pleural effusion caused by malignant tumors were recorded. It was shown that the increasing incidence of lung cancer in Silesia at that time caused the change of the profile of the Hospital of Lung Diseases and Tuberculosis.

  16. Pleural Nodules and Mediastinal Lymphadenopathy in a Smoker: An Unusual Case Report

    PubMed Central

    Desbuquoit, Damien; Van Hecke, Stijn; Even, Pjotr; Parizel, Paul M.; van Meerbeeck, Jan P.; Snoeckx, Annemie

    2016-01-01

    The authors report a case of thoracic splenosis, which is the autotransplantation of splenic tissue into the pleural cavity. Splenosis in the chest is a rare entity and most often an incidental finding on chest computed tomography, typically showing solitary or multiple well-defined, noncalcified pleural nodules of variable size in the left hemithorax. It is important to include this benign pathology in the differential diagnosis among other, generally malignant, pleural lesions. Imaging clues to the diagnosis are absence of the spleen and/or associated rib fractures. Early identification of thoracic splenosis as a cause of pleural nodules can prevent unnecessary and risky invasive procedures, such as biopsy or surgery. PMID:27721773

  17. [Diagnosis and treatment strategy of malignant pleural effusions in outpatient conditions].

    PubMed

    Klimenko, V N; Ivanov, O V

    2015-01-01

    According to results of the study, which included 52 patients with malignant pleural effusion of unknown etiology, it could be concluded that the method of choice in differential diagnosis of pleural effusion is the immunocytochemistry as the most informative method (efficacy 94,2%). Based on own experience of treatment of 137 patients with recurrent malignant pleural effusions, we can say that the first stage of treatment of pleural effusions is carrying out pleurodesis in outpatient conditions. The choice of pleurodesis method, first of all, depends on the aggressiveness of tumor pleurisy: in a case of daily exudation till 300 ml we choose talc pleurodesis, from 300 to 700--bleomycin pleurodesis, more than 700--combined (talc and bleomycin pleurodesis). The overall efficiency of produced pleurodesis is 64.5%. PMID:26995985

  18. Up-regulation of DDX39 in human malignant pleural mesothelioma cell lines compared to normal pleural mesothelial cells.

    PubMed

    Kuramitsu, Yasuhiro; Tominaga, Waka; Baron, Byron; Tokuda, Kazuhiro; Wang, Yufeng; Kitagawa, Takao; Nakamura, Kazuyuki

    2013-06-01

    Malignant pleural mesothelioma (MPM) is a malignant tumor originating from mesothelial cells existing in pleura. Since its incidence, it is closely related to the amount and time of exposure to asbestos, and the latency period after exposure to asbestos is very long, the incidence may increase over the next two decades. Since early detection is very difficult and there is no standard curative therapy, it is important to understand the biology of MPM, and to find biomarkers and molecular targets for its therapy. DDX39 is one of the Asp-Glu-Ala-Asp (DEAD)-box RNA helicases, which are required for the export of mRNA out of the nucleus, and transcription, splicing and transport of mRNA. Some reports have shown differential expression of DDX39 in tumor cells or tissues such as lung squamous cell cancer, gastrointestinal stromal tumor and urinary bladder cancer. In the present study, the protein levels of DDX39 in the human MPM cell lines NCI-H28, NCI-H2052 and NCI-H2452, and the human pleural mesothelial cell line MeT-5A were investigated by western blotting. The protein levels of DDX39 were found to be higher in NCI-H28, NCI-H2052 and NCI-H2452 compared to MeT-5A. The intensity of the bands of DDX39 in NCI-H28, NCI-H2052 and NCI-H2452 cells were increased by 1.351-, 1.887- and 2.024-fold, respectively, compared to MPM cells. These results suggest that DDX39 is a possible candidate biomarker for molecular-targeting of MPM.

  19. A topology-oriented and tissue-specific approach to detect pleural thickenings from 3D CT data

    NASA Astrophysics Data System (ADS)

    Buerger, C.; Chaisaowong, K.; Knepper, A.; Kraus, T.; Aach, T.

    2009-02-01

    Pleural thickenings are caused by asbestos exposure and may evolve into malignant pleural mesothelioma. The detection of pleural thickenings is today mostly done by a visual inspection of CT data, which is time-consuming and underlies the physician's subjective judgment. We propose a new detection algorithm within our computer-assisted diagnosis (CAD) system to automatically detect pleural thickenings within CT data. First, pleura contours are identified by thresholding and contour relaxation with a probabilistic model. Subsequently, the approach to automatically detect pleural thickenings is proposed as a two-step procedure. Step one; since pleural thickenings appear as fine-scale occurrences on the rather large-scale pleura contour, a surface-based smoothing algorithm is developed. Pleural thickenings are initially detected as the difference between the original contours and the resulting "healthy" model of the pleura. Step two; as pleural thickenings can expand into the surrounding thoracic tissue, a subsequent tissue-specific segmentation for the initially detected pleural thickenings is performed in order to separate pleural thickenings from the surrounding thoracic tissue. For this purpose, a probabilistic Hounsfield model for pleural thickenings as a mixture of Gaussian distributions has been constructed. The parameters were estimated by applying the Expectation-Maximization (EM) algorithm. A model fitting technique in combination with the application of a Gibbs-Markov random field (GMRF) model then allows the tissuespecific segmentation of pleural thickenings with high precision. With these methods, a new approach is presented in order to assure a precise and reproducible detection of pleural mesothelioma in its early stage.

  20. Differential Susceptibility of Human Pleural and Peritoneal Mesothelial Cells to Asbestos Exposure.

    PubMed

    Dragon, Julie; Thompson, Joyce; MacPherson, Maximilian; Shukla, Arti

    2015-08-01

    Malignant mesothelioma (MM) is an aggressive cancer of mesothelial cells of pleural and peritoneal cavities. In 85% of cases both pleural and peritoneal MM is caused by asbestos exposure. Although both are asbestos-induced cancers, the incidence of pleural MM is significantly higher (85%) than peritoneal MM (15%). It has been proposed that carcinogenesis is a result of asbestos-induced inflammation but it is not clear what contributes to the differences observed between incidences of these two cancers. We hypothesize that the observed differences in incidences of pleural and peritoneal MM are the result of differences in the direct response of these cell types to asbestos rather than to differences mediated by the in vivo microenvironment. To test this hypothesis we characterized cellular responses to asbestos in a controlled environment. We found significantly greater changes in genome-wide expression in response to asbestos exposure in pleural mesothelial cells as compared to peritoneal mesothelial cells. In particular, a greater response in many common genes (IL-8, ATF3, CXCL2, CXCL3, IL-6, GOS2) was seen in pleural mesothelial cells as compared to peritoneal mesothelial cells. Unique genes expressed in pleural mesothelial cells were mainly pro-inflammatory (G-CSF, IL-1β, IL-1α, GREM1) and have previously been shown to be involved in development of MM. Our results are consistent with the hypothesis that differences in incidences of pleural and peritoneal MM upon exposure to asbestos are the result of differences in mesothelial cell physiology that lead to differences in the inflammatory response, which leads to cancer.

  1. Ultrasound-guided pleural puncture in supine or recumbent lateral position - feasibility study

    PubMed Central

    2013-01-01

    Background The aim of this study is to evaluate feasibility, safety and efficacy of accessing the pleural space with the patient supine or in lateral recumbent position, under constant ultrasonic guidance along the costophrenic sinus. Methods All patients with pleural effusion, referred to thoracentesis or pleural drainage from February 2010 to January 2011 in two institutions, were drained either supine or in lateral recumbent position through an echomonitored cannulation of the costophrenic sinus. The technique is described in detail and an analysis of safety and feasibility is carried out. Results One hundred and one thoracenteses were performed on 76 patients and 30 pigtail catheters were inserted in 30 patients (for a total of 131 pleural procedures in 106 patients enrolled). The feasibility of the procedures was 100% and in every case it was possible to follow real time needle tip passage in the pleural space. Ninety eight thoracenteses (97%) and all catheter drainages were successfully completed. Four thoracenteses were stopped because of the appearance of complications while no pigtail drainage procedure was stopped. After 24 hour follow up, one chest pain syndrome (1.3% of completed thoracenteses) and two pneumothoraces (1.4%) occurred. The mean acquisition time of pleural space was 76 ± 9 seconds for thoracentesis and 185 ± 46 seconds for drainage insertion (p < 0.05). Conclusions This study highlights the safety and efficacy of this technique of real time echo-monitored pleural space puncture, that offers a more comfortable patient position, an easier approach for the operator, a very low rate of complications with short acquisition time of pleural space. PMID:23497643

  2. Bilateral total parenteral nutrition pleural effusions in a 5-week-old male infant

    PubMed Central

    Flannigan, Christopher; Bourke, Thomas; Keown, Karen; Terris, Mark

    2012-01-01

    A 5-week-old male infant was admitted to the paediatric intensive care unit with small bowel obstruction secondary to an inguinal hernia. His postoperative course was complicated by suspected migration of his left internal jugular central venous catheter into branches of the inferior thyroid artery and mediastinum. This resulted in bilateral pleural effusions which were biochemically and visually similar to the total parenteral nutrition he was receiving. After drainage of the pleural effusions he made an uneventful recovery. PMID:22761198

  3. Pleural malignant solitary fibrous tumor with sarcomatous overgrowth showing PDGFRbeta mutation.

    PubMed

    Rossi, Giulio; Schirosi, Laura; Giovanardi, Filippo; Sartori, Giuliana; Paci, Massimiliano; Cavazza, Alberto

    2006-08-01

    Pleural malignant solitary fibrous tumors (SFTs) are uncommon, and little is known about their histogenesis and molecular features. We report a case of pleural SFT with sarcomatous overgrowth that showed expression for PDGFRbeta and a missense mutation on exon 18 of the PDGFRbeta gene. The involvement of the PDGFRbeta gene in SFT is compatible with a pericytic derivation, also supporting a possible role of this tyrosine kinase in malignant transformation and in the adoption of novel molecular therapies.

  4. Incidence of pleural mesothelioma in New Caledonia: a 10-year survey (1978-1987).

    PubMed

    Goldberg, P; Goldberg, M; Marne, M J; Hirsch, A; Tredaniel, J

    1991-01-01

    All cases of primary pleural cancers that were reported during a 10-y period (i.e., 1978-1987) in New Caledonia were recorded and compared with five cancer registers. There was an excess of primary pleural cancers in the area of New Caledonia, and it was particularly evident among the Melanesian ethnic group. Neither geographical nor occupational factors accounted for these results, but an environmental factor could not be excluded.

  5. Differential susceptibility of human pleural and peritoneal mesothelial cells to asbestos exposure

    PubMed Central

    Dragon, Julie; Thompson, Joyce; MacPherson, Maximilian; Shukla, Arti

    2015-01-01

    Malignant mesothelioma (MM) is an aggressive cancer of mesothelial cells of pleural and peritoneal cavities. In 85% of cases both pleural and peritoneal MM is caused by asbestos exposure. Although both are asbestos-induced cancers, the incidence of pleural MM is significantly higher (85%) than peritoneal MM (15%). It has been proposed that carcinogenesis is a result of asbestos-induced inflammation but it is not clear what contributes to the differences observed between incidences of these two cancers. We hypothesize that the observed differences in incidences of pleural and peritoneal MM are the result of differences in the direct response of these cell types to asbestos rather than to differences mediated by the in vivo microenvironment. To test this hypothesis we characterized cellular responses to asbestos in a controlled environment. We found significantly greater changes in genome-wide expression in response to asbestos exposure in pleural mesothelial cells as compared to peritoneal mesothelial cells. In particular, a greater response in many common genes (IL-8, ATF3, CXCL2, CXCL3, IL-6, GOS2) was seen in pleural mesothelial cells as compared to peritoneal mesothelial cells. Unique genes expressed in pleural mesothelial cells were mainly pro-inflammatory (G-CSF, IL-1β, IL-1α, GREM1) and have previously been shown to be involved in development of MM. Our results are consistent with the hypothesis that differences in incidences of pleural and peritoneal MM upon exposure to asbestos are the result of differences in mesothelial cell physiology that lead to differences in the inflammatory response, which leads to cancer. PMID:25757056

  6. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center

    PubMed Central

    Liang, Weiqiang; Yu, Bin; Wang, Yipeng; Qiu, Guixing; Shen, Jianxiong; Zhang, Jianguo; Zhao, Hong; Zhao, Yu; Tian, Ye; Li, Shugang

    2016-01-01

    Objectives To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery. Methods The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression. Results Among the 28 patients with postoperative pleural effusion, 24 (85.7%) suffered from hemothorax, 2 (7.1%) from chylothorax, and 2 (7.1%) from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%), on the concave side in 4 patients (14.3%), and on both sides in 4 patients (14.3%). One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old), congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery. Conclusions The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325), and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old), congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion. PMID:27167221

  7. Targeting of plasminogen activator inhibitor 1 improves fibrinolytic therapy for tetracycline-induced pleural injury in rabbits.

    PubMed

    Florova, Galina; Azghani, Ali; Karandashova, Sophia; Schaefer, Chris; Koenig, Kathleen; Stewart-Evans, Kris; Declerck, Paul J; Idell, Steven; Komissarov, Andrey A

    2015-04-01

    Endogenous active plasminogen activator inhibitor 1 (PAI-1) was targeted in vivo with monoclonal antibodies (mAbs) that redirect its reaction with proteinases to the substrate branch. mAbs were used as an adjunct to prourokinase (single-chain [sc] urokinase [uPA]) intrapleural fibrinolytic therapy (IPFT) of tetracycline-induced pleural injury in rabbits. Outcomes of scuPA IPFT (0.25 or 0.0625 mg/kg) with 0.5 mg/kg of mouse IgG or mAbs (MA-33H1F7 and MA-8H9D4) were assessed at 24 hours. Pleural fluid (PF) was collected at 0, 10, 20, and 40 minutes and 24 hours after IPFT and analyzed for plasminogen activating (PA), uPA, fibrinolytic activities, levels of total plasmin/plasminogen, α-macroglobulin (αM), mAbs/IgG antigens, free active uPA, and αM/uPA complexes. Anti-PAI-1 mAbs, but not mouse IgG, delivered with an eightfold reduction in the minimal effective dose of scuPA (from 0.5 to 0.0625 mg/kg), improved the outcome of IPFT (P < 0.05). mAbs and IgG were detectable in PFs at 24 hours. Compared with identical doses of scuPA alone or with IgG, treatment with scuPA and anti-PAI-1 mAbs generated higher PF uPA amidolytic and PA activities, faster formation of αM/uPA complexes, and slower uPA inactivation. However, PAI-1 targeting did not significantly affect intrapleural fibrinolytic activity or levels of total plasmin/plasminogen and αM antigens. Targeting PAI-1 did not induce bleeding, and rendered otherwise ineffective doses of scuPA able to improve outcomes in tetracycline-induced pleural injury. PAI-1-neutralizing mAbs improved IPFT by increasing the durability of intrapleural PA activity. These results suggest a novel, well-tolerated IPFT strategy that is tractable for clinical development.

  8. Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time.

    PubMed

    Shepherd, K E; Oliver, L C; Kazemi, H

    1989-01-01

    This retrospective analysis reviews the clinical experience of a major urban referral hospital with diffuse malignant pleural mesothelioma during the 14-year period from 1973 through 1986. Seventy-five cases of definite or equivocal mesothelioma were identified. There were four cases of primary malignant peritoneal mesothelioma, seven cases of benign fibrous mesothelioma, and 64 cases of diffuse malignant pleural mesothelioma. In 43 cases (67%) of diffuse malignant pleural mesothelioma, there was historic evidence of asbestos exposure. In 21 cases (33%), there was no known history of asbestos exposure. An increase in annual incidence of diffuse malignant pleural mesothelioma was observed over the study period, from three cases in 1973 to ten cases in 1986. Despite greater awareness of this disease, the diagnosis remains a difficult one to establish given the nonspecific symptoms, signs and radiographic appearance, variable histologic appearance, and poor diagnostic sensitivity and specificity of thoracentesis and closed pleural biopsy. Thoracotomy, thoracoscopy, and CT-guided needle biopsies gave higher yields and are the diagnostic measures of choice when diffuse malignant pleural mesothelioma is suspected.

  9. Enhanced immune response of MAIT cells in tuberculous pleural effusions depends on cytokine signaling

    PubMed Central

    Jiang, Jing; Chen, Xinchun; An, Hongjuan; Yang, Bingfen; Zhang, Fuping; Cheng, Xiaoxing

    2016-01-01

    The functions of MAIT cells at the site of Mycobacterium tuberculosis infection in humans are still largely unknown. In this study, the phenotypes and immune response of MAIT cells from tuberculous pleural effusions and peripheral blood were investigated. MAIT cells in tuberculous pleural effusions had greatly enhanced IFN-γ, IL-17F and granzyme B response compared with those in peripheral blood. The level of IFN-γ response in MAIT cells from tuberculous pleural effusions was inversely correlated with the extent of tuberculosis infection (p = 0.0006). To determine whether cytokines drive the immune responses of MAIT cells at the site of tuberculosis infection, the role of IL-1β, IL-2, IL-7, IL-12, IL-15 and IL-18 was investigated. Blockade of IL-2, IL-12 or IL-18 led to significantly reduced production of IFN-γ and/or granzyme B in MAIT cells from tuberculous pleural effusions. Majority of IL-2-producing cells (94.50%) in tuberculous pleural effusions had phenotype of CD3+CD4+, and most IL-12p40-producing cells (91.39%) were CD14+ cells. MAIT cells had significantly elevated expression of γc receptor which correlated with enhanced immune responses of MAIT cells. It is concluded that MAIT cells from tuberculous pleural effusions exhibited highly elevated immune response to Mtb antigens, which are controlled by cytokines produced by innate/adaptive immune cells. PMID:27586092

  10. Enhanced immune response of MAIT cells in tuberculous pleural effusions depends on cytokine signaling.

    PubMed

    Jiang, Jing; Chen, Xinchun; An, Hongjuan; Yang, Bingfen; Zhang, Fuping; Cheng, Xiaoxing

    2016-01-01

    The functions of MAIT cells at the site of Mycobacterium tuberculosis infection in humans are still largely unknown. In this study, the phenotypes and immune response of MAIT cells from tuberculous pleural effusions and peripheral blood were investigated. MAIT cells in tuberculous pleural effusions had greatly enhanced IFN-γ, IL-17F and granzyme B response compared with those in peripheral blood. The level of IFN-γ response in MAIT cells from tuberculous pleural effusions was inversely correlated with the extent of tuberculosis infection (p = 0.0006). To determine whether cytokines drive the immune responses of MAIT cells at the site of tuberculosis infection, the role of IL-1β, IL-2, IL-7, IL-12, IL-15 and IL-18 was investigated. Blockade of IL-2, IL-12 or IL-18 led to significantly reduced production of IFN-γ and/or granzyme B in MAIT cells from tuberculous pleural effusions. Majority of IL-2-producing cells (94.50%) in tuberculous pleural effusions had phenotype of CD3(+)CD4(+), and most IL-12p40-producing cells (91.39%) were CD14(+) cells. MAIT cells had significantly elevated expression of γc receptor which correlated with enhanced immune responses of MAIT cells. It is concluded that MAIT cells from tuberculous pleural effusions exhibited highly elevated immune response to Mtb antigens, which are controlled by cytokines produced by innate/adaptive immune cells. PMID:27586092

  11. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions.

    PubMed

    Vargas, F S; Milanez, J R; Filomeno, L T; Fernandez, A; Jatene, A; Light, R W

    1994-12-01

    Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions. PMID:7988198

  12. Fluid fertilizers. [Fluids

    SciTech Connect

    Potts, J.M.

    1984-09-01

    The use of fertilizer in the United States has increased spectacularly in the past 20 years. In 1981 plant nutrient use (N + P/sub 2/O/sub 5/ + K/sub 2/O) totaled 23.5 million short tons - compared with only 7.5 million tons in 1960 (table 2). Nutrient use doubled from 1960 to 1970 and tripled from 1960 to 1981. In 1981 fluid nutrient use (mixtures plus nitrogen solutions) totaled 4.1 million tons, more than doubling since 1970 and increasing from 6.3% to 17.5% of the total nutrient use since 1960. Fluid mixtures (NPK) use in 1981 totaled 1.8 million tons of nutrients - about 17% of total mixed fertilizers or 7.5% of total nutrients used. The proportion of total fertilizer nutrients applied in fluid from increases greatly if anhydrous ammonia is included. The 4.6 million tons of nitrogen applied as anhydrous ammonia in 1981 increases total fluid nutrients to 8.1 million tons - 34.5% of the total nutrients applied in the United States. Fluid fertilizer use has grown nearly twice as fast as total fertilizer use, averaging more than 15% per year increase between 1960 and 1970, and an 11% increase between 1960 and 1980. A large part of this increase occurred during the introductory stages of the new product form and was aided by rapid advances in technology.

  13. A Multiplexed Cytokeratin Analysis Using Targeted Mass Spectrometry Reveals Specific Profiles in Cancer-Related Pleural Effusions.

    PubMed

    Domanski, Dominik; Perzanowska, Anna; Kistowski, Michal; Wojtas, Grzegorz; Michalak, Agata; Krasowski, Grzegorz; Dadlez, Michal

    2016-07-01

    Pleural effusion (PE), excess fluid in the pleural space, is often observed in lung cancer patients and also forms due to many benign ailments. Classifying it quickly is critical, but this remains an analytical challenge often lengthening the diagnosis process or exposing patients to unnecessary risky invasive procedures. We tested the analysis of PE using a multiplexed cytokeratin (CK) panel with targeted mass spectrometry-based quantitation for its rapid classification. CK markers are often assessed in pathological examinations for cancer diagnosis and guiding treatment course. We developed methods to simultaneously quantify 33 CKs in PE using peptide standards for increased analytical specificity and a simple CK enrichment method to detect their low amounts. Analyzing 121 PEs associated with a variety of lung cancers and noncancerous causes, we show that abundance levels of 10 CKs can be related to PE etiology. CK-6, CK-7, CK-8, CK-18, and CK-19 were found at significantly higher levels in cancer-related PEs. Additionally, elevated levels of vimentin and actin differentiated PEs associated with bacterial infections. A classifier algorithm effectively grouped PEs into cancer-related or benign PEs with 81% sensitivity and 79% specificity. A set of undiagnosed PEs showed that our method has potential to shorten PE diagnosis time. For the first time, we show that a cancer-relevant panel of simple-epithelial CK markers currently used in clinical assessment can also be quantitated in PEs. Additionally, while requiring less invasive sampling, our methodology demonstrated a significant ability to identify cancer-related PEs in clinical samples and thus could improve patient care in the future. PMID:27435923

  14. A Novel Combination of Calprotectin and CXCL12 for Predicting Malignancy in Patients with Exudative Pleural Effusion

    PubMed Central

    Luo, Jian; Wang, Maoyun; Li, Chuntao; Liang, Binmiao; Liu, Dan; Shi, Chaoli; Jiang, Faming; Wang, Ting; Li, Peijun; Liang, Zongan

    2015-01-01

    Abstract Pleural effusion (PE) remains a significant challenge and public health problem, which needs novel noninvasive biomarkers for the precise diagnosis. The aim of this study was to further determine the clinical efficacy and diagnostic accuracy of a novel combination of calprotectin and CXCL12 for predicting malignancy in patients with exudative PE. Calprotectin and CXCL12 concentrations were measured in 95 individuals of exudative PE, with 39 malignant PE (MPE) and 56 benign PE (BPE). The accuracy of calprotectin and CXCL12 levels for discriminating MPE from BPE or tuberculous PE were evaluated using receiver-operating characteristic (ROC) curves. Univariate and multivariate logistic regression analyses were performed to test the association between calprotectin and CXCL12 levels and MPE. Calprotectin and CXCL12 levels of patients with MPE were significantly lower than that of BPE and tuberculous PE (P < 0.05). The area under the curve (AUC) of calprotectin and CXCL12 was 0.683 and 0.641 in MPE and BPE, and a combination of calprotectin ≤500.19 ng/mL and CXCL12 ≤6.11 ng/mL rendered a sensitivity and specificity of 48.72% and 78.57%, respectively. While in MPE and tuberculous PE, the AUC of calprotectin and CXCL12 was 0.696 and 0.690, and a combination of calprotectin ≤421.73 ng/mL and CXCL12 ≤3.71 ng/mL presented a sensitivity and specificity of 25.64% and 95.45%, respectively. Multivariate logistic regression demonstrated that both calprotectin and CXCL12 were independent predictors of MPE. Calprotectin and CXCL12 in pleural fluid are informative diagnostic biomarkers for predicting patients with MPE. PMID:26632726

  15. Depth of Pleural Effusion in Thoracentesis: Comparison of Lateral, Posterolateral and Posterior Approaches in the Supine Position

    PubMed Central

    Ko, Jeong Min; Kim, Jisoon; Park, Soo-An; Jin, Kwang Nam; Ahn, Myeong Im; Kim, Seok-Chan; Han, Dae Hee

    2016-01-01

    Background In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. Objectives To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. Materials and Methods First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-to-large effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. Results In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the mid-axillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P < 0.001). In thirteen effusions (40.6%), DPE was greater than 1 cm in both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). Conclusion Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

  16. Procalcitonin as a Biomarker for a Bacterial Infection on Hospital Admission: A Critical Appraisal in a Cohort of Travellers with Fever after a Stay in (Sub)tropics

    PubMed Central

    Hesselink, Dennis A.; Bosmans-Timmerarends, Hanna; Burgerhart, Jan-Steven; Petit, Pieter L.; van Genderen, Perry J.

    2009-01-01

    Fever in a returned traveller may be the manifestation of a self-limiting, trivial infection but it can also presage an infection that can be rapidly progressive and lethal. We studied the diagnostic accuracy of procalcitonin (PCT) as a biomarker for a bacterial cause of fever in a cohort of 157 consecutive travellers with fever after a stay in the (sub)tropics. Elevated procalcitonin levels were observed not only in about 50% of travellers with proven bacterial infection, but also in a significant proportion of travellers with a likely infection. Using a cutoff point of 0.5 ng/mL, procalcitonin had a sensitivity of 0.52 and a specificity of 0.76 for a bacterial cause of fever on admission. Interestingly, only 1 out of 16 patients with a proven viral infection had a marginally elevated PCT concentration on admission, suggesting that an increased PCT level likely excludes a viral infection as the cause of fever. However, the diagnostic accuracy of this semiquantitative procalcitonin test for a bacterial cause of fever on admission is too poor to advocate its use in the initial clinical evaluation of fever in a setting of ill-returned travellers. PMID:20016801

  17. What is the best treatment for malignant pleural effusions?

    PubMed

    Zahid, Imran; Routledge, Tom; Billè, Andrea; Scarci, Marco

    2011-05-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether chemical pleurodesis is superior to catheter drainage or pleuroperitoneal shunts (PPS) in the management of patients with pleural effusions. Overall 161 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that chemical pleurodesis is superior to chronic catheter drainage and PPS in terms survival length and mortality rates but in patients with trapped lung syndrome chronic intrapleural catheter placement is indicated. Six studies reported patient outcomes after treatment with chemical pleurodesis. They report high success rates (89.4%) and low mortality rates (2%) without any need to convert to open thoracotomy. Mean hospital stay of 2.33 days, complication rates of 16.5% and mean survival length of 23.8 ± 16.3 months were observed. Five studies managed malignant pleural effusions (MPEs) using chronic indwelling catheters. They reported mean survival length of 126 days. Symptomatic relief was achieved in 94.2% of patients. There was a significant reduction in the Medical Research Council dyspnoea score (3.0-1.9, P < 0.001) and despite complication rates of 22%, comparable mortality rates (7.5%) were observed. Even in patients with trapped lung syndrome, mean survival length was 125 days with symptomatic improvement being achieved in 90.9% of patients. Three studies treated MPEs using PPSs. Mean hospital stay was 6.2 days (range 2-26) with a mean survival length of 11 months. Pleurodesis success rates varied from 57.1% to 95% with a complication rate of 14.8%. PPSs were shown to produce lower success rates (57.1% vs. 92.3%), shorter survival lengths (4.3 ± 1.9 vs. 6.7 ± 2.1 months) and higher complication rates (14.3% vs. 2

  18. Pre-Clinical Mouse Models of Primary and Metastatic Pleural Cancers of the Lung and Breast and the Use of Bioluminescent Imaging to Monitor Pleural Tumor Burden (ms#CP-10-0176)

    PubMed Central

    Servais, Elliot L.; Colovos, Christos; Kachala, Stefan S.; Adusumilli, Prasad S.

    2015-01-01

    Malignant pleural disease (MPD) results in an estimated 150,000 cases of malignant pleural effusions (MPE) annually. The most common malignancies associated with MPD are primary malignant pleural mesothelioma (MPM) and metastatic lung cancer, breast cancer and lymphoma. MPM is a rare, regionally aggressive, malignancy whose incidence is increasing secondary to the latency of disease progression. MPD is characteristic of advanced stage pleural disease and portends a grave clinical prognosis with a median survival between 3 to 12 months. Treatment for MPD is primarily palliative by thoracentesis to drain the effusion or surgical procedures to liberate trapped lung and obliterate cavities in order to limit subsequent collection of pleural effusions. Systemic chemotherapy is typically ineffective due to dose-limiting toxicities and poor intratumoral penetration. Preclinical investigations conducted in flank and intraperitoneal tumor models do not fully recapitulate the pleural tumor microenvironment and the results are not directly translational to the clinically setting. An orthotopic model of pleural malignancy allows investigators to evaluate the efficacy of therapies against novel molecular targets in a microenvironment that mimics the clinical tumor milieu. The protocol described herein provides a mouse model of MPM and MPD from non-hematogenous tumors resulting in reproducible tumor location, tumor progression, animal survival, and histopathology. Pleural tumor growth in this model resembles the regionally aggressive clinical course and tumor microenvironment of human pleural cancers and provides an optimal animal model to investigate MPD biology and therapies. PMID:21898334

  19. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes?

    PubMed Central

    Delevaux, I; Andre, M; Colombier, M; Albuisson, E; Meylheuc, F; Begue, R; Piette, J; Aumaitre, O

    2003-01-01

    Objective: To study the levels of procalcitonin (PCT) in various inflammatory states seen in an internal medicine department and to evaluate the possible discriminative role of PCT in differentiating bacterial infection from other inflammatory processes. Methods: PCT, C reactive protein (CRP), and white blood cell count (WBC) were measured in patients admitted to the department for fever or biological inflammatory syndrome, or both. The serum of 173 consecutive patients was analysed according to the aetiological diagnosis. The patients were divided into two groups: group I (n=60) with documented bacterial or fungal infection; group II (n=113) with abacterial inflammatory disease. Results: PCT levels were >0.5 ng/ml in 39/60 (65%) patients in group I. In group II, three patients with a viral infection had slightly increased PCT levels (0.7, 0.8, and 1.1 ng/ml) as did two others, one with crystal arthritis and the other with vasculitis (0.7 ng/ml in both cases). All other patients in group II had PCT levels <0.5 ng/ml. In this study a value of PCT >0.5 ng/ml was taken as the marker of bacterial infection (sensitivity 65%, specificity 96%). PCT values were more discriminative than WBC and CRP in distinguishing a bacterial infection from another inflammatory process. Conclusion: PCT levels only rose significantly during bacterial infections. In this study PCT levels >1.2 ng/ml were always evidence of bacterial infection and the cue for starting antibiotic treatment. PMID:12634233

  20. Procalcitonin in liver transplantation: are high levels due to donors or recipients?

    PubMed Central

    Eyraud, Daniel; Ben Ayed, Saïd; Tanguy, Marie Laure; Vézinet, Corinne; Siksik, Jean Michel; Bernard, Maguy; Fratéa, Sylvia; Movschin, Marie; Vaillant, Jean-Christophe; Coriat, Pierre; Hannoun, Laurent

    2008-01-01

    Introduction To date, a specific marker to evaluate and predict the clinical course or complication of the liver-transplanted patient is not available in clinical practice. Increased procalcitonin (PCT) levels have been found in infectious inflammation; poor organ perfusion and high PCT levels in the cardiac donor appeared to predict early graft failure. We evaluated PCT as a predictor of early graft dysfunction and postoperative complications. Methods PCT serum concentrations were measured in samples collected before organ retrieval from 67 consecutive brain-dead donors and in corresponding recipients from day 0, before liver transplantation, up to day 7 after liver transplantation. The following parameters were recorded in donors: amount of vasopressive drug doses, cardiac arrest history 24 hours before retrieval, number of days in the intensive care unit, age of donor, and infection in donor, and the following parameters were recorded in recipients: cold and warm ischemia time, veno-venous bypass, transfusion amount during orthotopic liver transplantation (OLT), and occurrence of postoperative complication or hepatic dysfunction. Results In the donor, the preoperative level of PCT was associated with cardiac arrest and high doses of catecholamines before organ retrieval. In the recipient, elevated PCT levels were observed early after OLT, with a peak at day 1 or 2 after OLT, then a decrease until day 7. A postoperative peak of PCT levels was associated neither with preoperative PCT levels in the donor or the recipients nor with hepatic post-OLT dysfunction or other postoperative complications, but with two donor parameters: infection and cardiac arrest. Conclusion PCT level in the donor and early PCT peak in the recipient are not predictive of post-OLT hepatic dysfunction or other complications. Cardiac arrest and infection in the donor, but not PCT level in the donor, are associated with high post-OLT PCT levels in the recipient. PMID:18601732

  1. Induction of procalcitonin in liver transplant patients treated with anti-thymocyte globulin

    PubMed Central

    Zazula, Roman; Prucha, Miroslav; Tyll, Tomas; Kieslichova, Eva

    2007-01-01

    Introduction The aim of this study was to compare the early postoperative kinetics of procalcitonin (PCT) and C-reactive protein (CRP) serum levels in patients undergoing orthotopic liver transplantation (OLTx) with different immunosuppressive regimens. Methods PCT and CRP serum concentrations were measured in a group of 28 OLTx recipients before induction of anesthesia, at 4 and 8 hours following graft reperfusion, and daily until postoperative day 4. The same parameters were determined in 12 patients undergoing liver resection without conjunctive immunosuppressive therapy. Summary data are expressed as medians and ranges. Two-tailed nonparametric tests were performed and considered significant at p values of less than 0.05. Results The highest serum levels of PCT (median 3.0 ng/mL, minimum 1.4 ng/mL, maximum 13.9 ng/mL) were found in patients after OLTx without ATG therapy, on postoperative day 1. In patients with ATG administration, PCT levels were highly increased on postoperative day 1 (median 53.0 ng/mL, minimum 7.9 ng/mL, maximum 249.1 ng/mL). Thereafter, PCT values continuously decreased independently of further ATG administration in both groups of patients. No evidence of infection was present in either group. In 12 patients undergoing liver resection, peak serum PCT levels did not exceed 3.6 ng/mL. CRP serum levels in a group of patients with and without ATG therapy increased significantly on postoperative day 1, followed by a decrease. The highest levels of CRP were found in patients after liver resection on postoperative day 2 and decreased thereafter. Conclusion ATG administration to patients with OLTx is associated with an increase in serum PCT levels, with peak values on postoperative day 1, and this was in the absence of any evidence of infection. The results of this study indicate that ATG immunosuppressive therapy is a stimulus for the synthesis of PCT. PMID:18088403

  2. Enzyme-free electrochemical immunosensor based on host-guest nanonets catalyzing amplification for procalcitonin detection.

    PubMed

    Shen, Wen-Jun; Zhuo, Ying; Chai, Ya-Qin; Yang, Zhe-Han; Han, Jing; Yuan, Ruo

    2015-02-25

    An enzyme-free electrochemical immunosensor based on the host-guest nanonets of N,N-bis(ferrocenoyl)-diaminoethane/β-cyclodextrins/poly(amidoamine) dendrimer-encapsulated Au nanoparticles (Fc-Fc/β-CD/PAMAM-Au) for procalcitonin (PCT) detection has been developed in this study. The signal probe was constructed as follows: amine-terminated β-CD was adsorbed to PAMAM-Au first, and then the prepared Fc-Fc was recognized by the β-CD to form stable host-guest nanonets. Next, secondary antibodies (Ab2) were attached into the formed netlike nanostructure of Fc-Fc/β-CD/PAMAM-Au by chemical absorption between PAMAM-Au and -NH2 of β-CD. Herein, the PAMAM-Au act not only as nanocarriers for anchoring large amounts of the β-CD and Ab2 but also as nanocatalysts to catalyze the oxidation of ascorbic acid (AA) for signal amplification. Moreover, the Fc-Fc could be stably immobilized by the hydrophobic inner cavity of β-CD as well as improving solubility by the hydrophilic exterior of β-CD. With the unique structure of two ferrocene units, Fc-Fc not only affords more electroactive groups to make the electrochemical response more sensitive but also plays a role of combining dispersive β-CD-functionalized PAMAM-Au to form the netlike nanostructure. Furthermore, Fc-Fc exhibits good catalytic activity for AA oxidation. When the detection solution contained AA, the synergetic catalysis of PAMAM-Au and Fc-Fc to AA oxidation could be obtained, realizing enzyme-free signal amplification. The proposed immunosensor provided a linear range from 1.80 pg/mL to 500 ng/mL for PCT detection and a detection limit of 0.36 pg/mL under optimal experimental conditions. Moreover, the immunosensor has shown potential application in clinical detection of PCT.

  3. [Procalcitonin. A new marker for acute phase reaction in acute pancreatitis].

    PubMed

    Bertsch, T; Richter, A; Hofheinz, H; Böhm, C; Hartel, M; Aufenanger, J

    1997-01-01

    Procalcitonin is a protein which is found in elevated concentrations in the blood circulation during systemic bacterial, fungal or protozoal infection. In contrast to classical acute-phase proteins like C-reactive protein or interleukin-6, it is not elevated after operative trauma. In this paper we present current opinions on the assumed induction mechanisms of the protein by cytokines and endotoxin. Furthermore, the clinical value for early detection of systemic infections in abdominal and transplantation surgery is demonstrated by examples from the literature. Our investigation shows that eight patients with necrotizing pancreatitis had a PCT mean value of 6.9 ng/ml on the day of admission. Seven patients with edematous pancreatitis had only a PCT mean value of 0.69 ng/ml. Despite these differences in the mean values, a significant difference between the normal value and the mean value of the group with necrotizing pancreatitis or edematous pancreatitis was not observed due to the wide range of PCT levels in the group of patients with necrotizing pancreatitis. The fact that only a few of the patients had a superinfected necrosis with systemic evasion of bacterias or their toxins may be the reason for this wide range. We suggest that a discrimination between superinfected necrotizing or sterile pancreatitis and edematous pancreatitis by PCT could be possible but more extensive studies with microbiological examination of the necrotic material are required to recognize the subgroups and to establish the real diagnostic efficiency of PCT in clinical practice, especially in the prediction of the outcome of acute pancreatitis.

  4. Antibiotic Treatment of Severe Exacerbations of Chronic Obstructive Pulmonary Disease with Procalcitonin: A Randomized Noninferiority Trial

    PubMed Central

    Verduri, Alessia; Luppi, Fabrizio; D’Amico, Roberto; Balduzzi, Sara; Vicini, Roberto; Liverani, Anna; Ruggieri, Valentina; Plebani, Mario; Barbaro, Maria Pia Foschino; Spanevello, Antonio; Canonica, Giorgio Walter; Papi, Alberto; Fabbri, Leonardo Michele; Beghè, Bianca

    2015-01-01

    Background The duration of antibiotic treatment of exacerbations of COPD (ECOPD) is controversial. Serum procalcitonin (PCT) is a biomarker of bacterial infection used to identify the cause of ECOPD. Methods and Findings We investigated whether a PCT-guided plan would allow a shorter duration of antibiotic treatment in patients with severe ECOPD. For this multicenter, randomized, non-inferiority trial, we enrolled 184 patients hospitalized with ECOPD from 18 hospitals in Italy. Patients were assigned to receive antibiotics for 10 days (standard group) or for either 3 or 10 days (PCT group). The primary outcome was the rate of ECOPD at 6 months. Having planned to recruit 400 patients, we randomized only 183: 93 in the PCT group and 90 in the standard group. Thus, the completed study was underpowered. The ECOPD rate at 6 months between PCT-guided and standard antibiotic treatment was not significant (% difference, 4.04; 90% confidence interval [CI], −7.23 to 15.31), but the CI included the non-inferiority margin of 15. In the PCT-guided group, about 50% of patients were treated for 3 days, and there was no difference in primary or secondary outcomes compared to patients treated for 10 days. Conclusions Although the primary and secondary clinical outcomes were no different for patients treated for 3 or 10 days in the PCT group, the conclusion that antibiotics can be safely stopped after 3 days in patients with low serum PCT cannot be substantiated statistically. Thus, the results of this study are inconclusive regarding the noninferiority of the PCT-guided plan compared to the standard antibiotic treatment. The study was funded by Agenzia Italiana del Farmaco (AIFA-FARM58J2XH). Clinical trial registered with www.clinicaltrials.gov (NCT01125098). Trial Registration ClinicalTrials.gov NCT01125098 PMID:25760346

  5. Procalcitonin: A New Biomarker for Medullary Thyroid Cancer? A Systematic Review.

    PubMed

    Karagiannis, Apostolos K A; Girio-Fragkoulakis, Constantine; Nakouti, Theodora

    2016-08-01

    Medullary thyroid cancer (MTC) is a rare but aggressive thyroid malignancy. The gold-standard biomarker for its diagnosis and follow-up is calcitonin (CT); however, it has a variable half-life dependent on its circadian variability. It has been suggested that a more stable hormone, procalcitonin (PCT), may overcome these problems and its introduction to routine practice may give more accurate results in the diagnosis and follow-up of MTC. We systematically reviewed Pubmed, Scopus, Biosis Previews and Embase databases up to March 2016. A total of 15 out of 184 articles were retrieved and analyzed. Of these 15 studies, 3 were case reports. In these 15 studies, the values of CT and PCT were assessed in both patients with MTC and patients that were either healthy volunteers or with benign/malignant thyroid nodular disease or with bacterial infection. Our search suggests that PCT seems to be a useful biomarker for the diagnosis and follow-up of MTC when used in conjunction with CT, particularly in a small proportion of tumors that are CT-negative or secrete low levels of CT. So far, there has not been enough data to suggest a specific threshold for normal PCT. However, most studies indicate a value of 0.1 ng/ml as an acceptable cut-off in everyday clinical practice. At present, CT should continue to be the primary biomarker in MTC with the addition of PCT in some patient groups. Nevertheless, larger patient series need to be conducted in order to provide safer and more accurate results. PMID:27466480

  6. Early-Onset Neonatal Sepsis: Still Room for Improvement in Procalcitonin Diagnostic Accuracy Studies.

    PubMed

    Chiesa, Claudio; Pacifico, Lucia; Osborn, John F; Bonci, Enea; Hofer, Nora; Resch, Bernhard

    2015-07-01

    To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS.We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies.We found 18 articles (1998-2014) fulfilling our eligibility criteria which were included in the final analysis. Overall, the results of our analysis showed that the quality of studies reporting diagnostic accuracy of PCT for EONS was suboptimal leaving ample room for improvement. Information on key elements of design, analysis, and interpretation of test accuracy were frequently missing.Authors should be aware of the STARD criteria before starting a study in this field. We welcome stricter adherence to this guideline. Well-reported studies with appropriate designs will provide more reliable information to guide decisions on the use and interpretations of PCT test results in the management of neonates with EONS.

  7. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target

    PubMed Central

    Becker, Kenneth L; Snider, Richard; Nylen, Eric S

    2010-01-01

    The worldwide yearly mortality from sepsis is substantial, greater than that of cancer of the lung and breast combined. Moreover, its incidence is increasing, and its response to therapy has not appreciably improved. In this condition, the secretion of procalcitonin (ProCT), the prohormone of calcitonin, is augmented greatly, attaining levels up to thousands of fold of normal. This hypersecretion emanates from multiple tissues throughout the body that are not traditionally viewed as being endocrine. The serum values of ProCT correlate with the severity of sepsis; they recede with its improvement and worsen with exacerbation. Accordingly, as highlighted in this review, serum ProCT has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inflammatory conditions. It is also a useful monitor of the clinical course and prognosis, and sensitive and specific assays have been developed for its measurement. Moreover, it has been demonstrated that the administration of ProCT to septic animals greatly increases mortality, and several toxic effects of ProCT have been elucidated by in vitro experimental studies. Antibodies have been developed that neutralize the harmful effects of ProCT, and their use markedly decreases the symptomatology and mortality of animals that harbour a highly virulent sepsis analogous to that occurring in humans. This therapy is facilitated by the long duration of serum ProCT elevation, which allows for a broad window of therapeutic opportunity. An experimental groundwork has been established that suggests a potential applicability of such therapy in septic humans. PMID:20002097

  8. Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

    PubMed Central

    Chakravarti, Sujata B; Reformina, Diane A; Lee, Timothy M; Malhotra, Sunil P; Mosca, Ralph S; Bhatla, Puneet

    2016-01-01

    Background: Bacterial infection (BI) after congenital heart surgery (CHS) is associated with increased morbidity and is difficult to differentiate from systemic inflammatory response syndrome caused by cardiopulmonary bypass (CPB). Procalcitonin (PCT) has emerged as a reliable biomarker of BI in various populations. Aim: To determine the optimal PCT threshold to identify BI among children suspected of having infection following CPB. Setting and Design: Single-center retrospective observational study. Materials and Methods: Medical records of all the patients admitted between January 2013 and April 2015 were reviewed. Patients in the age range of 0-21 years of age who underwent CHS requiring CPB in whom PCT was drawn between postoperative days 0-8 due to suspicion of infection were included. Statistical Analysis: The Wilcoxon rank-sum test was used for nonparametric variables. The diagnostic performance of PCT was evaluated using a receiver operating characteristic (ROC) curve. Results: Ninety-eight patients were included. The median age was 2 months (25th and 75th interquartile of 0.1-7.5 months). Eleven patients were included in the BI group. The median PCT for the BI group (3.42 ng/mL, 25th and 75th interquartile of 2.34-5.67) was significantly higher than the median PCT for the noninfected group (0.8 ng/mL, 25th and 75th interquartile 0.38-3.39), P = 0.028. The PCT level that yielded the best compromise between the sensitivity (81.8%) and specificity (66.7%) was 2 ng/mL with an area under the ROC curve of 0.742. Conclusion: A PCT less than 2 ng/mL makes BI unlikely in children suspected of infection after CHS. PMID:27212844

  9. Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

    PubMed Central

    Yang, Yongtao; Li, Lianyong; Qu, Changmin; Zeng, Bolun; Liang, Shuwen; Luo, Zhiwen; Wang, Xiaoying; Zhong, Changqing

    2015-01-01

    Abstract Early diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. The aim of this study is to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease. After performing a systematic search of the Medline, Embase, and Cochrane databases for studies that evaluated the diagnostic role of PCT for SBP, sensitivity, specificity, and other measures of accuracy of PCT concentrations in serum for SBP diagnosis were pooled using random-effects models. A summary receiver operating characteristic curve was used to summarize overall test performance. Seven publications met the inclusion criteria covering 742 episodes of suspected SBP along with 339 confirmed cases. The summary estimates for serum PCT in the diagnosis of SBP attributable to end-stage liver disease were: sensitivity 0.82 (95% CI 0.79–0.87), specificity 0.86 (95% CI 0.82–0.89), positive likelihood ratio 4.94 (95% CI 2.28–10.70), negative likelihood ratio 0.22 (95% CI 0.10–0.52), and diagnostic OR 22.55 (95% CI 7.01–108.30). The area under the curve was 0.92. There was evidence of significant heterogeneity but no evidence of publication bias. Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings. PMID:26656333

  10. Pleural plaque profiles on the chest radiographs and CT scans of asbestos-exposed Japanese construction workers.

    PubMed

    Elshazley, Momen; Shibata, Eiji; Hisanaga, Naomi; Ichihara, Gaku; Ewis, Ashraf A; Kamijima, Michihiro; Ichihara, Sahoko; Sakai, Kiyoshi; Sato, Mitsuo; Kondo, Masashi; Hasegawa, Yoshinori

    2011-01-01

    Pleural plaques are asymptomatic focal thickenings of the pleura and considered the hallmark of asbestos exposure. However, it is often difficult to detect pleural plaques on chest x-rays (CXR). In a retrospective study, using chest CT scans of 140 Japanese asbestos-exposed construction workers who have probable or definite findings of pleural plaque on CXR; firstly, we proposed plaque morphology-based classification for CXR findings, and then we examined if those classified findings could be confirmed as pleural plaques on CT scans. Our morphology-based classification of pleural plaque findings included nine types. The percentages of confirmed pleural plaques on CT scans by type (number of confirmed pleural plaque on CT/number of observed on CXR) were 93% (40/43) for straight, 89% (56/63) for diamond, 88% (7/8) for double, 83% (19/23) for tapered medially, 80% (20/25) for parallel, 77% (23/30) for crescent, 79% (11/14) for tenting, 72% (18/25) for tapered-laterally (long type), and 0% (0/9) for tapered-laterally (short type). When added to the ILO classification, morphology-based classification of CXR pleural plaque findings makes its detection easier and hence chest radiograph continues to be a suitable tool for screening asbestos-related pleural plaques based on its simplicity, low radiation exposure, wide availability and cost-effectiveness. PMID:21828957

  11. Dasatinib-induced pleural effusion: Chylothorax, an option to consider

    PubMed Central

    Ferreiro, Lucía; San-José, Esther; Suárez-Antelo, Juan; Valdés, Luis

    2016-01-01

    Dasatinib is a drug for treatment of oncogene fusion protein BCR-ABL-positive chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia resistant/intolerant to imatinib. Pleural effusion (PE) is a common adverse effect, and in this context, we present four cases seen due to this cause. One of them is a chylothorax. The PE grade is variable, and the physiopathology is not well established, although a block in T-lymphocyte function or inhibition of platelet-derived growth factor receptor-β is suggested being involved. The PE is generally a lymphocyte-predominant exudate, but can also present as chylothorax. Several factors have been associated with its appearance, particularly the administration in two daily doses. Low grade (1–2) PEs usually respond well to interrupt the treatment while those of higher grade may also require therapeutic thoracentesis and corticosteroids. There are currently no firm guidelines that establish when to resort to one form of treatment or another. PMID:27803756

  12. Current Issues in Malignant Pleural Mesothelioma Evaluation and Management

    PubMed Central

    Ai, Jing

    2014-01-01

    Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer. PMID:25061089

  13. [Incidence of pleural mesotheliomas in Poland (preliminary report)].

    PubMed

    Szturmowicz, M; Vertun-Baranowska, B; Rowińska-Zakrzewska, E; Szymańska, D

    1991-01-01

    Mesothelioma is a rare malignancy, difficult to diagnose and rarely found in a population not exposed to asbestos. In the immediate past incidence rates of this disease have increased due to extensive use of this mineral in the industry of the 1950's. The aim of this study was to assess the incidence of mesotheliomas basing on results of a questionnaire posted in 1987 to all pneumonology clinics, oncological departments in Poland, and data from the Central Oncological Register from the years 1970-1985. Incidence of this malignant disease was 1-2 cases per 1,000,000 of general population during the years 1970-1985 and did not rise in 1986. Regional differences were observed, in some areas the incidence rate was 5-6 per 1,000,000. Data from the Occupational Medicine Institute disclosed in these regions more extensive industrial use of this mineral. The authors have also concluded that "at-life" diagnosis of mesothelioma rises, mainly due to the use of open pleural biopsy.

  14. Gene-asbestos interaction in malignant pleural mesothelioma susceptibility.

    PubMed

    Tunesi, Sara; Ferrante, Daniela; Mirabelli, Dario; Andorno, Silvano; Betti, Marta; Fiorito, Giovanni; Guarrera, Simonetta; Casalone, Elisabetta; Neri, Monica; Ugolini, Donatella; Bonassi, Stefano; Matullo, Giuseppe; Dianzani, Irma; Magnani, Corrado

    2015-10-01

    Asbestos exposure is the main risk factor for malignant pleural mesothelioma (MPM), a rare aggressive tumor. Nevertheless, on average less than 10% of subjects highly exposed to asbestos develop MPM, suggesting the possible involvement of other risk factors. To identify the genetic factors that may modulate the risk of MPM, we conducted a gene-environment interaction analysis including asbestos exposure and 15 single nucleotide polymorphisms (SNPs) previously identified through a genome-wide association study on Italian subjects. In the present study, we assessed gene-asbestos interaction on MPM risk using relative excess risk due to interaction and synergy index for additive interaction and V index for multiplicative interaction. Generalized multifactor dimensionality reduction (GMDR) analyses were also performed. Positive deviation from additivity was found for six SNPs (rs1508805, rs2501618, rs4701085, rs4290865, rs10519201, rs763271), and four of them (rs1508805, rs2501618, rs4701085, rs10519201) deviated also from multiplicative models. However, after Bonferroni correction, deviation from multiplicative model was still significant for rs1508805 and rs4701085 only. GMDR analysis showed a strong MPM risk due to asbestos exposure and suggested a possible synergistic effect between asbestos exposure and rs1508805, rs2501618 and rs5756444. Our results suggested that gene-asbestos interaction may play an additional role on MPM susceptibility, given that asbestos exposure appears as the main risk factor.

  15. Lipid-rich pleural mesothelioma in a dog.

    PubMed

    Avakian, Arlen; Alroy, Joseph; Rozanski, Elizabeth; Keating, John; Rosenberg, Andrew

    2008-09-01

    An 11-year-old, neutered, male Golden Retriever cross dog was euthanized following a history of recurrent pericardial effusions. At necropsy, blood-tinged pericardial and intrathoracic effusions were seen along with numerous firm to hard plaque-like masses that studded the epicardial, pericardial, mediastinal, and costal pleural surfaces. Within the right thorax, the lesions coalesced into a large mass that occupied most of the cavity. Histologically, the masses were composed of solid sheets and papillary aggregates of medium-sized polygonal cells that contained abundant vacuolated to clear cytoplasm. Some of the cytoplasmic vacuoles stained positive with oil red O. The stroma contained metaplastic trabeculae of woven and lamellar bone. Immunohistochemically, the neoplastic cells expressed vimentin, pancytokeratin, and S-100 protein. Transmission electron microscopy corroborated the presence of intracytoplasmic vacuoles and demonstrated prominent intercellular junctional complexes and apically located microvilli. These findings are consistent with a lipid-rich variant of mesothelioma. To the authors' knowledge, this is the first report of a lipid-rich mesothelioma in a dog.

  16. Intercellular communication in malignant pleural mesothelioma: properties of tunneling nanotubes

    PubMed Central

    Ady, Justin W.; Desir, Snider; Thayanithy, Venugopal; Vogel, Rachel I.; Moreira, André L.; Downey, Robert J.; Fong, Yuman; Manova-Todorova, Katia; Moore, Malcolm A. S.; Lou, Emil

    2014-01-01

    Malignant pleural mesothelioma is a particularly aggressive and locally invasive malignancy with a poor prognosis despite advances in understanding of cancer cell biology and development of new therapies. At the cellular level, cultured mesothelioma cells present a mesenchymal appearance and a strong capacity for local cellular invasion. One important but underexplored area of mesothelioma cell biology is intercellular communication. Our group has previously characterized in multiple histological subtypes of mesothelioma a unique cellular protrusion known as tunneling nanotubes (TnTs). TnTs are long, actin filament-based, narrow cytoplasmic extensions that are non-adherent when cultured in vitro and are capable of shuttling cellular cargo between connected cells. Our prior work confirmed the presence of nanotube structures in tumors resected from patients with human mesothelioma. In our current study, we quantified the number of TnTs/cell among various mesothelioma subtypes and normal mesothelial cells using confocal microscopic techniques. We also examined changes in TnT length over time in comparison to cell proliferation. We further examined potential approaches to the in vivo study of TnTs in animal models of cancer. We have developed novel approaches to study TnTs in aggressive solid tumor malignancies and define fundamental characteristics of TnTs in malignant mesothelioma. There is mounting evidence that TnTs play an important role in intercellular communication in mesothelioma and thus merit further investigation of their role in vivo. PMID:25400582

  17. Lipid-rich pleural mesothelioma in a dog.

    PubMed

    Avakian, Arlen; Alroy, Joseph; Rozanski, Elizabeth; Keating, John; Rosenberg, Andrew

    2008-09-01

    An 11-year-old, neutered, male Golden Retriever cross dog was euthanized following a history of recurrent pericardial effusions. At necropsy, blood-tinged pericardial and intrathoracic effusions were seen along with numerous firm to hard plaque-like masses that studded the epicardial, pericardial, mediastinal, and costal pleural surfaces. Within the right thorax, the lesions coalesced into a large mass that occupied most of the cavity. Histologically, the masses were composed of solid sheets and papillary aggregates of medium-sized polygonal cells that contained abundant vacuolated to clear cytoplasm. Some of the cytoplasmic vacuoles stained positive with oil red O. The stroma contained metaplastic trabeculae of woven and lamellar bone. Immunohistochemically, the neoplastic cells expressed vimentin, pancytokeratin, and S-100 protein. Transmission electron microscopy corroborated the presence of intracytoplasmic vacuoles and demonstrated prominent intercellular junctional complexes and apically located microvilli. These findings are consistent with a lipid-rich variant of mesothelioma. To the authors' knowledge, this is the first report of a lipid-rich mesothelioma in a dog. PMID:18776107

  18. Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion

    PubMed Central

    Verma, Akash; Taha, Aza; Venkateswaran, Sridhar; Tee, Augustine

    2015-01-01

    INTRODUCTION This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion. METHODS We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013. RESULTS Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%. CONCLUSION MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions. PMID:26034319

  19. Detection of pleural plaques in workers exposed to inhalation of natural fluoro-edenite fibres

    PubMed Central

    RAPISARDA, VENERANDO; LEDDA, CATERINA; RICCERI, VINCENZO; ARENA, FRANCESCO; MUSUMECI, ANDREA; MARCONI, ANDREA; FAGO, LUCREZIA; BRACCI, MASSIMO; SANTARELLI, LORY; FERRANTE, MARGHERITA

    2015-01-01

    Fluoro-edenite is a natural mineral species initially isolated in Biancavilla, Sicily. The fibres are similar in size and morphology to certain amphibolic asbestos fibres, the inhalation of which may cause chronic inflammation and cancer. Occupational asbestos exposure is known to be associated with pleural and lung diseases, including pleural plaques. The aim of this study was to report the pleural and lung parenchymal lesions detected by high-resolution computed tomography (HRCT) in a group of construction workers exposed to fluoro-edenite. Information regarding life habits and occupational history was collected from 43 workers enrolled into the study. The participants underwent physical examination, blood analysis, search for uncoated fibres and ferruginous bodies in the sputum, pulmonary function tests, including diffusion capacity for carbon monoxide (TLCO), and HRCT chest imaging. A general descriptive outcome analysis was also conducted; a prevalence ratio (PR) with 95% confidence interval and a two-tailed test P-value were calculated for pleural plaques using log-binomial regression, measuring plaque size and thickness, and cumulative exposure index (CEI). The mean values of the functional respiratory tests were within the normal range for all participants. A restrictive ventilatory defect was identified in two (5%) subjects and an obstructive ventilatory defect in three (7%) subjects. TLCO was reduced in two additional participants. Fibres were detected in 19 (44%) of subjects. Pleural involvement was documented in 39 (91%) workers, of whom 31 (72%) had bilateral plaques. Calcifications were detected in 25 (58%) of these participants. PR indicated a progressive increase in the risk of developing pleural lesions with rising CEI, i.e. length of exposure. The present findings demonstrate for the first time the presence of pleural plaques in the lungs of subjects exposed to fluoro-edenite fibres, and not to asbestos, through residing in Biancavilla and through

  20. Unilateral pleural effusion in an animal model: evaluation of lung function with EBCT

    NASA Astrophysics Data System (ADS)

    Recheis, Wolfgang A.; Pallwein, Leo; Soegner, Peter; Faschingbauer, Ralph; Schmidbauer, Georg; Kleinsasser, Axel; Loeckinger, Alexander; Hoermann, Christoph; zur Nedden, Dieter

    2003-05-01

    The purpsoe was to evaluate the influence of a right-sided pleural effusion on the lung aeration dynamics in the respiratory cycle during pressure controlled ventilation. Pleural effusion was simulated by infusion of 3% gelatin into the pleural cavity in steps of 300ml totaling 1200ml in four anesthetized pigs. After each step, volume scans and respirator gated 50ms scans at a constant table position (carina niveau) were taken. The dynamic changes of the previously defined air-tissue ratios (in steps of 100HU) were evaluated in three separate regions of left and right lung: a ventral, an intermediate and a dorsal area. The affected side revealed dramatic alveolar collapse. There was a shift of the lung density to higher air-tissue ratios (+200HU) but showing the same air-tissue ratio dynamics. A slight lateral shift of 32mm (+/-14mm) the mediastinum was measured. The unaffected side showed no increase in the air-tissue ratios caused by hyperinflation but an increase of density due to mediastinal shift. Air-tissue ratio dynamics remained unchanged on the unaffected side compared to baseline measurements. We visualized the ventilation mismatch caused by pleural effusion. The contra-lateral lung is not affected by unilateral pleural effusion. Pressure controlled ventilation prevents hyper-inflation of non-dependent lung areas.

  1. Pleural effusion associated with acute and chronic pleuropneumonia and pleuritis secondary to thoracic wounds in horses: 43 cases (1982-1992).

    PubMed

    Collins, M B; Hodgson, D R; Hutchins, D R

    1994-12-15

    Case records of 43 horses with pleural effusion associated with acute pleuropneumonia, chronic pleuropneumonia, or pleuritis secondary to a penetrating thoracic wound were reviewed to determine the predisposing factors, diagnosis, and treatment of this condition. Acute pleuropneumonia was diagnosed in 36 horses, the majority of which were Thoroughbreds (89%). Of 22 (61%) horses that were in race training at the onset of illness, 11 (31%) had been recently transported a long distance and 4 (11%) had evidence of exercise-induced pulmonary hemorrhage. Physical examination findings and hematologic data were nonspecific. The most consistent abnormality was hyperfibrino-genemia. Affected horses were treated with antibiotics, thoracic drainage, nonsteroidal anti-inflammatory drugs, and supportive care. Twenty-two (61%) horses were discharged from the hospital, with the mean duration of hospitalization for those discharged being 23 days. Nine (25%) horses were euthanatized and 5 (14%) died. Bacterial culturing of thoracic fluid resulted in growth in 30 of the 36 (83%) horses. The finding of anaerobic bacteria in thoracic fluid was not associated with a lower survival rate (62%) than the overall survival rate (61%). Four horses with chronic pleuropneumonia had a history of lethargy and inappetence for > 2 weeks. Actinobacillus equuli was isolated, either alone or in combination with other bacteria, from thoracic fluid of these 4 horses. Each horse was treated with broad spectrum antibiotics and made a rapid recovery. Three horses with acute pleuritis secondary to penetrating thoracic wounds also had nonspecific clinical signs, apart from the wound and a large volume of pleural effusion. Bacteriologic isolates from these horses differed slightly from those of horses with acute pleuropneumonia. PMID:7744650

  2. Diarachidonoylphosphoethanolamine induces necrosis/necroptosis of malignant pleural mesothelioma cells.

    PubMed

    Kaku, Yoshiko; Tsuchiya, Ayako; Kanno, Takeshi; Nakano, Takashi; Nishizaki, Tomoyuki

    2015-09-01

    The present study investigated 1,2-diarachidonoyl-sn-glycero-3-phosphoethanolamine (DAPE)-induced cell death in malignant pleural mesothelioma (MPM) cells. DAPE reduced cell viability in NCI-H28, NCI-H2052, NCI-H2452, and MSTO-211H MPM cell lines in a concentration (1-100μM)-dependent manner. In the flow cytometry using propidium iodide (PI) and annexin V (AV), DAPE significantly increased the population of PI-positive and AV-negative cells, corresponding to primary necrosis, and that of PI-positive and AV-positive cells, corresponding to late apoptosis/secondary necrosis, in NCI-H28 cells. DAPE-induced reduction of NCI-H28 cell viability was partially inhibited by necrostatin-1, an inhibitor of RIP1 kinase to induce necroptosis, or knocking-down RIP1. DAPE generated reactive oxygen species (ROS) followed by disruption of mitochondrial membrane potentials in NCI-H28 cells. DAPE-induced mitochondrial damage was attenuated by cyclosporin A, an inhibitor of cyclophilin D (CypD). DAPE did not affect expression and mitochondrial localization of p53 protein in NCI-H28 cells. DAPE significantly decreased intracellular ATP concentrations in NCI-H28 cells. Overall, the results of the present study indicate that DAPE induces necroptosis and necrosis of MPM cells; the former is mediated by RIP1 kinase and the latter is caused by generating ROS and opening CypD-dependent mitochondrial permeability transition pore, to reduce intracellular ATP concentrations.

  3. Cul4A is an oncogene in malignant pleural mesothelioma.

    PubMed

    Hung, Ming-Szu; Mao, Jian-Hua; Xu, Zhidong; Yang, Cheng-Ta; Yu, Jau-Song; Harvard, Chansonette; Lin, Yu-Ching; Bravo, Dawn Therese; Jablons, David M; You, Liang

    2011-02-01

    Cullin 4A (Cul4A) is important in cell survival, development, growth and the cell cycle, but its role in mesothelioma has not been studied. For the first time, we identified amplification of the Cul4A gene in four of five mesothelioma cell lines. Consistent with increased Cul4A gene copy number, we found that Cul4A protein was overexpressed in mesothelioma cells as well. Cul4A protein was also overexpressed in 64% of primary malignant pleural mesothelioma (MPM) tumours. Furthermore, knockdown of Cul4A with shRNA in mesothelioma cells resulted in up-regulation of p21 and p27 tumour suppressor proteins in a p53-independent manner in H290, H28 and MS-1 mesothelioma cell lines. Knockdown of Cul4A also resulted in G0/G1 cell cycle arrest and decreased colony formation in H290, H28 and MS-1 mesothelioma cell lines. Moreover, G0/G1 cell cycle arrest was partially reversed by siRNA down-regulation of p21 and/or p27 in Cul4A knockdown H290 cell line. In the contrary, overexpression of Cul4A resulted in down-regulation of p21 and p27 proteins and increased colony formation in H28 mesothelioma cell line. Both p21 and p27 showed faster degradation rates in Cul4A overexpressed H28 cell line and slower degradation rates in Cul4A knockdown H28 cell line. Our study indicates that Cul4A amplification and overexpression play an oncogenic role in the pathogenesis of mesothelioma. Thus, Cul4A may be a potential therapeutic target for MPM.

  4. Thrombomodulin expression in malignant pleural mesothelioma and pulmonary adenocarcinoma.

    PubMed

    Collins, C L; Ordonez, N G; Schaefer, R; Cook, C D; Xie, S S; Granger, J; Hsu, P L; Fink, L; Hsu, S M

    1992-10-01

    Thrombomodulin (TM) is a glycoprotein of molecular weight 75,000 kd that is normally present in restricted numbers of cells, including endothelial and mesothelial cells. In this study, the authors tested the possibility of using anti-TM to facilitate the diagnosis of mesothelioma. All of the 31 mesotheliomas and the two mesothelioma cell lines (MS-1 and MS-2) tested were stained positively with anti-TM. The specificity of anti-TM staining in mesothelioma cells was further confirmed by in situ hybridization of MS-1 cells with a TM-specific probe. The expression of TM in MS-1 cells was increased markedly when these cells were induced by 12-0-tetradecanyl phorbol 13-acetate (TPA) to differentiate. The expression of TM in mesothelioma cells, however, did not correlate with any particular phase of the cell cycle. In an attempt to differentiate pleural mesothelioma from pulmonary adenocarcinoma, the authors compared the expression of TM, carcinoembryonic antigen (CEA), and Leu M1 in these two types of tumors. Only four of 48 (8%) pulmonary adenocarcinomas were stained positively by antibodies to TM. Therefore, immunohistochemical staining with antibodies to TM yielded 100% sensitivity and 92% specificity for diagnosis of mesothelioma. All of the mesotheliomas stained negatively for CEA and Leu M1, except for one, which showed minimal focal positivity for Leu M1. In contrast, 79% and 60% of adenocarcinomas stained positively for CEA and Leu M1, respectively. These findings suggest that immunocytochemical staining with anti-TM should be added to the battery of tests to increase the diagnostic sensitivity and specificity for differentiating mesothelioma from pulmonary adenocarcinoma.

  5. Proton Therapy for Malignant Pleural Mesothelioma After Extrapleural Pleuropneumonectomy

    SciTech Connect

    Krayenbuehl, Jerome; Hartmann, Matthias; Lomax, Anthony J.

    2010-10-01

    Purpose: To perform comparative planning for intensity-modulated radiotherapy (IMRT) and proton therapy (PT) for malignant pleural mesothelioma after radical surgery. Methods and Materials: Eight patients treated with IMRT after extrapleural pleuropneumonectomy (EPP) were replanned for PT, comparing dose homogeneity, target volume coverage, and mean and maximal dose to organs at risk. Feasibility of PT was evaluated regarding the dose distribution with respect to air cavities after EPP. Results: Dose coverage and dose homogeneity of the planning target volume (PTV) were significantly better for PT than for IMRT regarding the volume covered by >95% (V95) for the high-dose PTV. The mean dose to the contralateral kidney, ipsilateral kidney, contralateral lung, liver, and heart and spinal cord dose were significantly reduced with PT compared with IMRT. After EPP, air cavities were common (range, 0-850 cm{sup 3}), decreasing from 0 to 18.5 cm{sup 3}/day. In 2 patients, air cavity changes during RT decreased the generalized equivalent uniform dose (gEUD) in the case of using an a value of < - 10 to the PTV2 to <2 Gy in the presence of changing cavities for PT, and to 40 Gy for IMRT. Small changes were observed for gEUD of PTV1 because PTV1 was reached by the beams before air. Conclusion: Both PT and IMRT achieved good target coverage and dose homogeneity. Proton therapy accomplished additional dose sparing of most organs at risk compared with IMRT. Proton therapy dose distributions were more susceptible to changing air cavities, emphasizing the need for adaptive RT and replanning.

  6. Diagnostic and prognostic value of procalcitonin levels in patients with Bell's palsy.

    PubMed

    Kilicaslan, Saffet; Uluyol, Sinan; Gur, Mehmet Hafit; Arslan, Ilker Burak; Yagiz, Ozlem

    2016-06-01

    Inflammation is thought to play an important role in the pathogenesis of Bell's palsy (BP). Procalcitonin (PCT) is currently among the most frequently used proinflammatory biomarkers in clinical practice. In this study, we assessed the serum PCT levels for predicting the severity and prognosis of BP. In total, 32 patients with House-Brackmann (HB) grade II and III BP (low-grade group), 22 patients with HB grade IV and V (high-grade group) and 35 healthy individuals (control group) were included in this prospective study. PCT levels were compared among these three groups at the time of diagnosis. All patients received standard prednisolone and acyclovir treatment. The correlation between PCT levels and recovery was analyzed 3 months after treatment. The PCT levels for control, low-grade and high-grade BP groups were 0.01 ± 0.001, 0.35 ± 0.05, and 0.98 ± 0.41 ng/mL, respectively. The PCT level in low-grade group was significantly higher than that in control group (p < 0.001), and the PCT level in high-grade BP group was significantly higher than that in low-grade group (p = 0.01, p < 0.05). The complete recovery rate was 93.7 % in low-grade and 54.5 % in high-grade BP group (p = 0.015, p < 0.05). There was a strong negative correlation between PCT levels and recovery rates (r = -0.896, p < 0.001). PCT levels were significantly associated with the severity of BP and higher PCT levels were related with poor clinical outcome in terms of recovery. These results support the diagnostic and prognostic significance of PCT in patients with early BP. PMID:26894418

  7. Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

    PubMed Central

    López Sastre, José B; Pérez Solís, David; Roqués Serradilla, Vicente; Fernández Colomer, Belén; Coto Cotallo, Gil D; Krauel Vidal, Xavier; Narbona López, Eduardo; García del Río, Manuel; Sánchez Luna, Manuel; Belaustegui Cueto, Antonio; Moro Serrano, Manuel; Urbón Artero, Alfonso; Álvaro Iglesias, Emilio; Cotero Lavín, Ángel; Martínez Vilalta, Eduardo; Jiménez Cobos, Bartolomé

    2006-01-01

    Background It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12–24 h and 36–48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated. Results The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36–48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12–24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36–48 h of birth (sensitivity 86.5%, specificity 72.7%). Conclusion Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be

  8. Procalcitonin Is a Marker of Gram-Negative Bacteremia in Patients With Sepsis

    PubMed Central

    Guo, Shun Yuan; Zhou, Yin; Hu, Qing Feng; Yao, Jiong

    2015-01-01

    Abstract: Background: Prediction of the species of pathogen among patients with sepsis within hours would be helpful in accelerating proper treatment. As a potential method of shortening the time to identification, this study considered the usefulness of measuring procalcitonin (PCT) to predict blood culture (BC) results. Methods: The authors retrospectively analyzed the data of patients with a diagnosis of sepsis in their hospital from December 2012 to December 2013. The authors analyzed all diagnostic episodes consisting of BC and PCT concentration. The diagnostic performance of PCT to predict gram-negative bacteremia was tested using a receiver operative characteristic curve. Logistic regression was constructed using the presence of gram-negative bacteria as the dependent variable. Results: A total of 262 diagnostic episodes met the inclusion criteria. According to BC classifications, a significantly higher value of PCT was observed in bloodstream infections caused by gram-negative bacteria (26.7 ng/mL, 0.09–188.3) than that in bloodstream infections caused by gram-positive bacteria (0.84 ng/mL, 0.05–18.79) or Candida spp. (1.12 ng/mL, 0.07–49.68). A cutoff value of ≥3.39 ng/mL for PCT showed a sensitivity of 80%, a specificity of 71%, a positive predictive value of 35%, a negative predictive value of 91% and an area under the curve of 0.73 for gram-negative bacteremia identification by BC. Among the 122 diagnostic episodes with positive BC results, a cutoff value of ≥6.47 ng/mL for PCT yielded a sensitivity of 74%, a specificity of 81%, a positive predictive value of 82%, a negative predictive value of 75% and an area under the curve of 0.81 for gram-negative bacteremia identification. Conclusions: PCT may represent a useful tool for differentiating gram-positive from gram-negative bloodstream infection with a significantly higher PCT level indicating gram-negative bacteremia. PMID:25992537

  9. Procalcitonin Predicts Real-Time PCR Results in Blood Samples from Patients with Suspected Sepsis

    PubMed Central

    Mencacci, Antonella; Leli, Christian; Cardaccia, Angela; Meucci, Marta; Moretti, Amedeo; D'Alò, Francesco; Farinelli, Senia; Pagliochini, Rita; Barcaccia, Mariella; Bistoni, Francesco

    2012-01-01

    Background Early diagnosis and rapid bacterial identification are of primary importance for outcome of septic patients. SeptiFast® (SF) real-time PCR assay is of potential utility in the etiological diagnosis of sepsis, but it cannot replace blood culture (BC) for routine use in clinical laboratory. Procalcitonin (PCT) is a marker of sepsis and can predict bacteremia in septic patients. The aim of the present study was to investigate whether PCT serum levels could predict SF results, and could help screening febrile patients in which a SF assay can improve the etiological diagnosis of sepsis. Methods From 1009 febrile patients with suspected sepsis, 1009 samples for BC, SF real-time PCR, and PCT determination were obtained simultaneously, and results were compared and statistically analysed. Receiver operating characteristic (ROC) curves were generated to determine the area under the curve and to identify which cut-off of PCT value produced the best sensitivity to detect SF results. Results Mean PCT values of sera drawn simultaneously with samples SF positive (35.42±61.03 ng/ml) or BC positive (23.14±51.56 ng/ml) for a pathogen were statistically higher than those drawn simultaneously with SF negative (0.84±1.67 ng/ml) or BC negative (2.79±16.64 ng/ml) samples (p<0.0001). For SF, ROC analysis showed an area under the curve of 0.927 (95% confidence interval: 0.899–0.955, p<0.0001). The PCT cut-off value of 0.37 ng/ml showed a negative predictive value of 99%, reducing the number of SF assays of 53.9%, still identifying the 96.4% of the pathogens. Conclusion PCT can be used in febrile patients with suspected sepsis to predict SF positive or negative results. A cut-off value of 0.37 ng/ml can be considered for optimal sensitivity, so that, in the routine laboratory activity, SF assay should not be used for diagnosis of sepsis in an unselected patient population with a PCT value <0.37 ng/ml. PMID:23300907

  10. Chyliform effusion without pleural thickening in a patient with rheumatoid arthritis: A case report

    PubMed Central

    Muresan, Crina; Muresan, Lucian; Grigorescu, Ioana; Dumitrascu, Dan L

    2015-01-01

    Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura. There have only been a few case reports in the literature on pseudochylothorax unassociated with pleural thickening and with a short duration of articular symptoms in patients with RA. We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan. The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment. PMID:26664172

  11. Pleural lesions and the ILO classification: the need for a revision.

    PubMed

    Hillerdal, G

    1991-01-01

    The ILO system for radiographic classification of pneumoconioses is a very important epidemiological tool. Unfortunately, the classification is not precise for pleural lesions, which are especially important for evaluation of asbestos-related diseases. The classification cannot separate extrapleural fat from diffuse thickening of the pleura, nor large plaques from diffuse thickening. In this paper, a short review of the different lesions are given and a revised scheme is suggested. This scheme includes as separate lesions: pleural fat; lesions of the parietal pleura, i.e., pleural plaques; and lesions of the visceral pleura, i.e., diffuse thickening and rounded atelectasis. The extent and width, as in the present ILO scheme, could be abolished.

  12. Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases.

    PubMed

    Selçuk, Z T; Cöplü, L; Emri, S; Kalyoncu, A F; Sahin, A A; Bariş, Y I

    1992-09-01

    We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.

  13. Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases

    SciTech Connect

    Selcuk, Z.T.; Coeplue, L.Em.; Emri, S.; Kalyoncu, A.F.; Sahin, A.A.; Baris, Y.I. )

    1992-09-01

    We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.

  14. Empyema Necessitans Complicating Pleural Effusion Associated with Proteus Species Infection: A Diagnostic Dilemma

    PubMed Central

    Yauba, M. S.; Ahmed, H.; Imoudu, I. A.; Yusuf, M. O.; Makarfi, H. U.

    2015-01-01

    Background. Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. infection. Methods. We describe a 12-year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. Results. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation. Conclusion. Empyema necessitatis is a rare condition that can be caused by Gram negative bacterial pathogens like Proteus species. PMID:25893125

  15. Pleural liquid and kinetic friction coefficient of mesothelium after mechanical ventilation.

    PubMed

    Bodega, Francesca; Sironi, Chiara; Porta, Cristina; Zocchi, Luciano; Agostoni, Emilio

    2015-01-15

    Volume and protein concentration of pleural liquid in anesthetized rabbits after 1 or 3h of mechanical ventilation, with alveolar pressure equal to atmospheric at end expiration, were compared to those occurring after spontaneous breathing. Moreover, coefficient of kinetic friction between samples of visceral and parietal pleura, obtained after spontaneous or mechanical ventilation, sliding in vitro at physiological velocity under physiological load, was determined. Volume of pleural liquid after mechanical ventilation was similar to that previously found during spontaneous ventilation. This finding is contrary to expectation of Moriondo et al. (2005), based on measurement of lymphatic and interstitial pressure. Protein concentration of pleural liquid after mechanical ventilation was also similar to that occurring after spontaneous ventilation. Coefficient of kinetic friction after mechanical ventilation was 0.023±0.001, similar to that obtained after spontaneous breathing.

  16. Horseshoe lung--a case report with unusual bronchial and pleural anomalies and a proposed new classification.

    PubMed

    Figa, F H; Yoo, S J; Burrows, P E; Turner-Gomes, S; Freedom, R M

    1993-01-01

    One case of horseshoe lung with associated scimitar syndrome is presented. Unusual bronchial and pleural anomalies as delineated by CT and plain chest radiographic imaging are described. The presence of bilateral fissures led to a newly proposed classification of horseshoe lung based on pleural anatomy. PMID:8469591

  17. A systematic review of the association between pleural plaques and changes in lung function

    PubMed Central

    Kopylev, Leonid; Christensen, Krista Yorita; Brown, James S; Cooper, Glinda S

    2015-01-01

    Objectives To conduct a systematic review of changes in lung function in relation to presence of pleural plaques in asbestos-exposed populations. Methods Database searches of PubMed and Web of Science were supplemented by review of papers’ reference lists and journals’ tables of contents. Methodological features (eg, consideration of potential confounding by smoking) of identified articles were reviewed by ≥two reviewers. Meta-analyses of 20 studies estimated a summary effect of the decrements in per cent predicted (%pred) forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) associated with presence of pleural plaques. Results Among asbestos-exposed workers, the presence of pleural plaques was associated with statistically significant decrements in FVC (4.09%pred, 95% CI 2.31 to 5.86) and FEV1 (1.99%pred, 95% CI 0.22 to 3.77). Effects of similar magnitude were seen when stratifying by imaging type (X-ray or high-resolution CT) and when excluding studies with potential methodological limitations. Undetected asbestosis was considered as an unlikely explanation of the observed decrements. Several studies provided evidence of an association between size of pleural plaques and degree of pulmonary decrease, and presence of pleural plaques and increased rate or degree of pulmonary impairment. Conclusions The presence of pleural plaques is associated with a small, but statistically significant mean difference in FVC and FEV1 in comparison to asbestos-exposed individuals without plaques or other abnormalities. From a public health perspective, small group mean decrements in lung function coupled with an increased rate of decline in lung function of the exposed population may be consequential. PMID:25504898

  18. Near Infrared Photoimmunotherapy in the Treatment of Pleural Disseminated NSCLC: Preclinical Experience

    PubMed Central

    Sato, Kazuhide; Nagaya, Tadanobu; Choyke, Peter L.; Kobayashi, Hisataka

    2015-01-01

    Pleural metastases are common in patients with advanced thoracic cancers and are a cause of considerable morbidity and mortality yet is difficult to treat. Near Infrared Photoimmunotherapy (NIR-PIT) is a cancer treatment that combines the specificity of intravenously injected antibodies for targeting tumors with the toxicity induced by photosensitizers after exposure to NIR-light. Herein, we evaluate the efficacy of NIR-PIT in a mouse model of pleural disseminated non-small cell lung carcinoma (NSCLC). In vitro and in vivo experiments were conducted with a HER2, luciferase and GFP expressing NSCLC cell line (Calu3-luc-GFP). An antibody-photosensitizer conjugate (APC) consisting of trastuzumab and a phthalocyanine dye, IRDye-700DX, was synthesized. In vitro NIR-PIT cytotoxicity was assessed with dead staining, luciferase activity, and GFP fluorescence intensity. In vivo NIR-PIT was performed in mice with tumors implanted intrathoracic cavity or in the flank, and assessed by tumor volume and/or bioluminescence and fluorescence thoracoscopy. In vitro NIR-PIT-induced cytotoxicity was light dose dependent. In vivo NIR-PIT led significant reductions in both tumor volume (p = 0.002 vs. APC) and luciferase activity (p = 0.0004 vs. APC) in a flank model, and prolonged survival (p < 0.0001). Bioluminescence indicated that NIR-PIT lead to significant reduction in pleural dissemination (1 day after PIT; p = 0.0180). Fluorescence thoracoscopy confirmed the NIR-PIT effect on disseminated pleural disease. In conclusion, NIR-PIT has the ability to effectively treat pleural metastases caused by NSCLC in mice. Thus, NIR-PIT is a promising therapy for pleural disseminated tumors. PMID:25897335

  19. Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

    PubMed Central

    Terra, Ricardo Mingarini; Waisberg, Daniel Reis; de Almeida, José Luiz Jesus; Devido, Marcela Santana; Pêgo-Fernandes, Paulo Manuel; Jatene, Fabio Biscegli

    2012-01-01

    OBJECTIVE: We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients. METHODS: This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005), open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008), videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm) observed by chest scan. The patients were divided into an old algorithm (n = 93) and new algorithm (n = 113) group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge) and the occurrence of complications. RESULTS: Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p<0.01). The patients in the new algorithm group were older (41±1 vs. 46.3±16.7 years, p = 0.014) and had higher Charlson Comorbidity Index scores [0(0-3) vs. 2(0-4), p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p = 0.35), although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04). CONCLUSIONS: The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery. PMID:22760892

  20. Quantitation in inflammatory pleural disease to distinguish tuberculous and paramalignant from chronic non-specific pleuritis.

    PubMed Central

    Capelozzi, V L; Saldiva, P H; Antonângelo, L; de Carvalho, T S; Logulo, A; de Carvalho, C R; Deheinzelin, D

    1997-01-01

    AIM: To determine by morphometry if pleural biopsies with the histopathological diagnosis of "non-specific pleuritis", malignant, and tuberculous disease could be distinguished morphologically from those with truly non-specific disease. METHODS: Each pleural biopsy was reviewed taking into account three compartments of reference: the visceral/parietal mesothelial compartment, the submesothelial screen compartment, and the submesothelial adipose tissue compartment. Normal connective tissue, granulation tissue, fibrocellular proliferation, fibrin, polymorphonuclear cells, mononuclear cells, and mesothelial cells were measured using conventional point counting procedures in terms of the fractional area occupied by each parameter within each compartment of reference. Ranking was carried out on 164 patients, based on their diagnosis: chronic non-specific disease (n = 57), tuberculosis (n = 27), malignant disease (n = 58), and conditions associated with transudative effusions (n = 22). RESULTS: Stepwise discriminant analysis of the resulting data showed that biopsies from patients with tuberculosis, malignant disease, and chronic non-specific disease could be distinguished between themselves and normal cases. Statistical differences among the four groups were observed for eight morphometric parameters related to components of inflammation and extension throughout the three pleural anatomical compartments. A robust discriminant function permitted an adequate classification of the three groups of disease in 88.41% of the cases. Pleural biopsies with fibrin incorporated within granulation tissue on the submesothelial screen compartment showed 100% specificity for patients with tuberculosis, while mononuclear cells in a band-like infiltrate on the submesothelial adipose tissue compartment showed 93.1% specificity for patients with malignant disease. The truly non-specific pleuritis was characterised by deposits of fibrin in the subpleural compartment and discrete signs of

  1. Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review.

    PubMed

    Pessôa, Fernanda Miraldi Clemente; de Melo, Alessandro Severo Alves; Souza, Arthur Soares; de Souza, Luciana Soares; Hochhegger, Bruno; Zanetti, Gláucia; Marchiori, Edson

    2016-08-01

    The aim of this review was to present the main aspects of pleural diseases seen with conventional and advanced magnetic resonance imaging (MRI) techniques. This modality is considered to be the gold standard for the evaluation of the pleural interface, characterization of complex pleural effusion, and identification of exudate and hemorrhage, as well as in the analysis of superior sulcus tumors, as it enables more accurate staging. The indication for MRI of the thorax in the identification of these conditions is increasing in comparison to computerized tomography, and it can also be used to support the diagnosis of pulmonary illnesses. This literature review describes the morphological and functional aspects of the main benign and malignant pleural diseases assessed with MRI, including mesothelioma, metastasis, lymphoma, fibroma, lipoma, endometriosis, asbestos-related pleural disease, empyema, textiloma, and splenosis. PMID:27300447

  2. Cynara scolymus affects malignant pleural mesothelioma by promoting apoptosis and restraining invasion.

    PubMed

    Pulito, Claudio; Mori, Federica; Sacconi, Andrea; Casadei, Luca; Ferraiuolo, Maria; Valerio, Maria Cristina; Santoro, Raffaela; Goeman, Frauke; Maidecchi, Anna; Mattoli, Luisa; Manetti, Cesare; Di Agostino, Silvia; Muti, Paola; Blandino, Giovanni; Strano, Sabrina

    2015-07-20

    Malignant pleural mesothelioma is a poorly treated neoplasia arising from the pleural mesothelial lining. Here we document that the leaf extract of Cynara scolymus exerts broad antitumoral effects both in vitro and in vivo on mesothelioma cell lines. We found that Cynara scolymus treatment affects strongly cell growth, migration and tumor engraftment of mesothelioma cell lines. Strikingly, dietary feeding with Cynara scolymus leaf extract reduces the growth of mesothelioma xenografted tumors similarly to pemetrexed, a commonly employed drug in the treatment of mesothelioma. In aggregate our findings suggest that leaf extract of Cynara scolymus holds therapeutic potential for the treatment of mesothelioma. PMID:26136339

  3. Costal Mesenchymal Chondrosarcoma with Diffuse Pleural and Pericardial Explantation in a Pygmy Goat

    PubMed Central

    Lombardini, Eric D.; de la Concha, Andres; Pierce, Virginia; Pool, Roy R.

    2014-01-01

    A 3 year old intact male pygmy goat developed progressive weakness and eventual recumbancy over the course of 1 week, while maintaining its ability to eat and drink. The animal died and at necropsy, the parietal pleural surfaces and the pericardial surface were noted to be covered with firm, white, variably sized nodules that often formed linear arrays or coalesced into larger clumped aggregates. The visceral pleural surfaces of the ventral lung lobes were also covered with similar nodules. Histopathological and immunohistochemical evaluation of the submitted tissues revealed a diagnosis of mesenchymal chondrosarcoma with extensive seeding throughout the thoracic cavity. PMID:24791071

  4. Left pleural effusion caused by pancreaticopleural fistula with a pancreatic pseudocyst.

    PubMed

    Hirosawa, Takanobu; Shimizu, Taro; Isegawa, Takuya; Tanabe, Mayo

    2016-01-01

    Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. The authors described a case of a man with medical history of alcohol-related chronic pancreatitis, presented with dyspnoea. The roentgenogram showed a massive left pleural effusion. Additional work-up revealed a pancreaticopleural fistula and amylase-rich pleural effusion. His respiratory state improved after the insertion of chest drainage tube. During his admission, conservative and endoscopic therapy was required for the treatment of his complication of mediastinal abscess and arterial aneurysm in the pancreatic pseudocyst. PMID:27558195

  5. Cynara scolymus affects malignant pleural mesothelioma by promoting apoptosis and restraining invasion

    PubMed Central

    Pulito, Claudio; Mori, Federica; Sacconi, Andrea; Casadei, Luca; Ferraiuolo, Maria; Valerio, Maria Cristina; Santoro, Raffaela; Goeman, Frauke; Maidecchi, Anna; Mattoli, Luisa; Manetti, Cesare; Di Agostino, Silvia; Muti, Paola; Blandino, Giovanni; Strano, Sabrina

    2015-01-01

    Malignant pleural mesothelioma is a poorly treated neoplasia arising from the pleural mesothelial lining. Here we document that the leaf extract of Cynara scolymus exerts broad antitumoral effects both in vitro and in vivo on mesothelioma cell lines. We found that Cynara scolymus treatment affects strongly cell growth, migration and tumor engraftment of mesothelioma cell lines. Strikingly, dietary feeding with Cynara scolymus leaf extract reduces the growth of mesothelioma xenografted tumors similarly to pemetrexed, a commonly employed drug in the treatment of mesothelioma. In aggregate our findings suggest that leaf extract of Cynara scolymus holds therapeutic potential for the treatment of mesothelioma. PMID:26136339

  6. Cynara scolymus affects malignant pleural mesothelioma by promoting apoptosis and restraining invasion.

    PubMed

    Pulito, Claudio; Mori, Federica; Sacconi, Andrea; Casadei, Luca; Ferraiuolo, Maria; Valerio, Maria Cristina; Santoro, Raffaela; Goeman, Frauke; Maidecchi, Anna; Mattoli, Luisa; Manetti, Cesare; Di Agostino, Silvia; Muti, Paola; Blandino, Giovanni; Strano, Sabrina

    2015-07-20

    Malignant pleural mesothelioma is a poorly treated neoplasia arising from the pleural mesothelial lining. Here we document that the leaf extract of Cynara scolymus exerts broad antitumoral effects both in vitro and in vivo on mesothelioma cell lines. We found that Cynara scolymus treatment affects strongly cell growth, migration and tumor engraftment of mesothelioma cell lines. Strikingly, dietary feeding with Cynara scolymus leaf extract reduces the growth of mesothelioma xenografted tumors similarly to pemetrexed, a commonly employed drug in the treatment of mesothelioma. In aggregate our findings suggest that leaf extract of Cynara scolymus holds therapeutic potential for the treatment of mesothelioma.

  7. The potential of molecular diagnostics and serum procalcitonin levels to change the antibiotic management of community-acquired pneumonia.

    PubMed

    Gilbert, David; Gelfer, Gita; Wang, Lian; Myers, Jillian; Bajema, Kristina; Johnston, Michael; Leggett, James

    2016-09-01

    Two diagnostic bundles were compared in 127 evaluable patients admitted with community-acquired pneumonia (CAP). Diagnostic modalities in all patients included cultures of sputum (if obtainable) and blood, urine for detection of the antigens of Streptococcus pneumoniae and Legionella pneumophila, and nasal swabs for PCR probes for S. pneumoniae and Staphylococcus aureus. At least one procalcitonin level was measured in all patients. For virus detection, patients were randomized to either a 5-virus, lab-generated PCR panel or the broader and faster FilmArray PCR panel. Overall, an etiologic diagnosis was established in 71% of the patients. A respiratory virus was detected in 39%. The potential for improved antibiotic stewardship was evident in 25 patients with only detectable respiratory virus and normal levels of PCT. PMID:27377675

  8. Dose-Volume Histogram Parameters and Clinical Factors Associated With Pleural Effusion After Chemoradiotherapy in Esophageal Cancer Patients

    SciTech Connect

    Shirai, Katsuyuki; Tamaki, Yoshio; Kitamoto, Yoshizumi; Murata, Kazutoshi; Satoh, Yumi; Higuchi, Keiko; Nonaka, Tetsuo; Ishikawa, Hitoshi; Katoh, Hiroyuki; Takahashi, Takeo; Nakano, Takashi

    2011-07-15

    Purpose: To investigate the dose-volume histogram parameters and clinical factors as predictors of pleural effusion in esophageal cancer patients treated with concurrent chemoradiotherapy (CRT). Methods and Materials: Forty-three esophageal cancer patients treated with definitive CRT from January 2001 to March 2007 were reviewed retrospectively on the basis of the following criteria: pathologically confirmed esophageal cancer, available computed tomography scan for treatment planning, 6-month follow-up after CRT, and radiation dose {>=}50 Gy. Exclusion criteria were lung metastasis, malignant pleural effusion, and surgery. Mean heart dose, mean total lung dose, and percentages of heart or total lung volume receiving {>=}10-60 Gy (Heart-V{sub 10} to V{sub 60} and Lung-V{sub 10} to V{sub 60}, respectively) were analyzed in relation to pleural effusion. Results: The median follow-up time was 26.9 months (range, 6.7-70.2) after CRT. Of the 43 patients, 15 (35%) developed pleural effusion. By univariate analysis, mean heart dose, Heart-V{sub 10} to V{sub 60}, and Lung-V{sub 50} to V{sub 60} were significantly associated with pleural effusion. Poor performance status, primary tumor of the distal esophagus, and age {>=}65 years were significantly related with pleural effusion. Multivariate analysis identified Heart-V{sub 50} as the strongest predictive factor for pleural effusion (p = 0.01). Patients with Heart-V{sub 50} <20%, 20%{<=} Heart-V{sub 50} <40%, and Heart-V{sub 50} {>=}40% had 6%, 44%, and 64% of pleural effusion, respectively (p < 0.01). Conclusion: Heart-V{sub 50} is a useful parameter for assessing the risk of pleural effusion and should be reduced to avoid pleural effusion.

  9. Pleural malignant mesothelioma, genetic susceptibility and asbestos exposure.

    PubMed

    Neri, Monica; Filiberti, Rosangela; Taioli, Emanuela; Garte, Seymour; Paracchini, Valentina; Bolognesi, Claudia; Canessa, Pier Aldo; Fontana, Vincenzo; Ivaldi, Giovanni Paolo; Verna, Anna; Bonassi, Stefano; Puntoni, Riccardo

    2005-12-30

    Pleural malignant mesothelioma (MM) is a rare but extremely aggressive cancer. The limited impact of standard therapeutic treatments on survival rates makes the identification of factors that increase the individual risk a leading priority. The high proportion of cases explained by exposure to asbestos has guided intervention policies to an effective ban of this compound from our environment. However, MM cannot be solely attributed to this agent, and the role of predisposing factors and their interaction with asbestos exposure is increasingly studied. The role of mEH, GSTM1, GSTT1, NAT2, and CYP1A1 genotypes in modulating susceptibility to MM was examined in a case-control study of 80 subjects with a confirmed diagnosis of MM and 255 controls. Subjects with low mEH activity showed a significantly increased risk of MM (OR, 2.51; 95% CI, 1.11-5.68). The association was stronger in the group with low asbestos exposure (OR, 7.83; 95% CI, 0.98-62.60). A significant increased risk of MM was also found in NAT2 fast acetylators (OR, 1.74; 95% CI, 1.02-2.96). The presence of synergisms between genotypes, i.e., mEH and NAT2 (LRT for heterogeneity p<0.023), mEH and GSTM1 (LRT p<0.061), and NAT2 and GSTM1 (LRT p<0.049), combined with the interaction observed with exposure to asbestos, suggests the presence of gene-environment and gene-gene interactions in the development of MM, although the size of the study group does not allow to draw clearcut conclusions. Since genetic polymorphisms can also modify the extent of genetic damage occurring in subjects exposed to carcinogens, we measured the frequency of micronuclei in peripheral blood lymphocytes of a subgroup of MM cases. The limited number of cases (28) did not allow to observe significant effects. In conclusion, these results strengthen the hypothesis that individual susceptibility to MM can be modulated by the interaction between polymorphic genes involved in the metabolism and the intensity of asbestos exposure.

  10. Malignant Pleural Effusion Supernatants Are Substitutes for Metastatic Pleural Tumor Tissues in EGFR Mutation Test in Patients with Advanced Lung Adenocarcinoma

    PubMed Central

    Wu, Ning; Nie, Xiaomeng; Xia, Yang; Han, Yiping; Li, Qiang; Zhu, Guanshan; Bai, Chong

    2014-01-01

    Background Though the possibility of using malignant pleural effusions (MPEs) as alternatives for metastatic pleural tumor tissues (MPTTs) in epidermal growth factor receptor (EGFR) mutation test has been examined, due to the lack of studies comparing the results in matching MPEs and MPTTs, the clinical value of MPEs for advanced adenocarcinoma patients with pleural effusions is not confirmed. Methods EGFR mutation statuses in matching MPTTs, MPE supernatants and cell blocks, of 41 patients with advanced lung adenocarcinoma as diagnosed by thoracoscopy were analyzed using amplification refractory mutation system (ARMS). Results EGFR mutations were detected in 46.3% (19/41) of MPTTs, 43.9% (18/41) of MPE supernatants and 56.3% (18/32) of MPE cell blocks by ARMS analysis. Generally, the same EGFR statuses were identified in both MPTTs and matching MPE cell blocks of 81.3% patients (26/32), whereas MPTTs and matching MPE supernatants of 87.8% (36/41) patients shared the same EGFR status. Compared with EGFR mutation detection in MPTTs, the sensitivity of EGFR mutation detection in MPE-cell blocks was 87.5% (14/16), specificity was 75.0% (12/16), while the sensitivity of EGFR mutation detection in MPE-supernatants was 84.2% (16/19), specificity was 90.9% (20/22). Conclusions The high concordance of EGFR mutation statuses between MPEs and MPTTs in lung adenocarcinoma patients with pleural metastasis as determined by ARMS analysis suggests that MPEs, particularly MPE supernatants, may be substitutes for MPTTs in EGFR mutation test. PMID:24587142

  11. Fluid Mechanics.

    ERIC Educational Resources Information Center

    Drazin, Philip

    1987-01-01

    Outlines the contents of Volume II of "Principia" by Sir Isaac Newton. Reviews the contributions of subsequent scientists to the physics of fluid dynamics. Discusses the treatment of fluid mechanics in physics curricula. Highlights a few of the problems of modern research in fluid dynamics. Shows that problems still remain. (CW)

  12. A Fever in Acute Aortic Dissection is Caused by Endogenous Mediators that Influence the Extrinsic Coagulation Pathway and Do Not Elevate Procalcitonin.

    PubMed

    Inoue Arita, Yoshie; Akutsu, Koichi; Yamamoto, Takeshi; Kawanaka, Hidekazu; Kitamura, Mitsunobu; Murata, Hiroshige; Miyachi, Hideki; Hosokawa, Yusuke; Tanaka, Keiji; Shimizu, Wataru

    2016-01-01

    Objective A fever is observed in approximately one-third of cases of acute aortic dissection (AAD); however, the causes remain unclear. We investigated the mechanism of a fever in AAD by measuring the serum concentrations of inflammatory markers, mediators of coagulation and fibrinolysis, and procalcitonin, a marker of bacterial infection. Methods We retrospectively studied 43 patients with medically treated AAD without apparent infection. Patients were divided into those with (Group A; n=19) and without (Group B; n=24) a maximum body temperature >38°C. We established which patients fulfilled the criteria for systemic inflammatory response syndrome (SIRS), and its relationship with a fever was examined. Mediators of inflammation, coagulation and fibrinolysis were compared by a univariate analysis. Factors independently associated with a fever were established by a multivariate analysis. Results The criteria for SIRS were fulfilled in a greater proportion of patients in Group A (79%) than in Group B (42%, p=0.001). There was no difference in the procalcitonin concentration between Groups A and B (0.15±0.17 ng/mL vs. 0.11±0.12 ng/mL, respectively; p=0.572). Serum procalcitonin concentrations lay within the normal range in all patients in whom it was measured, which showed that the fever was caused by endogenous mediators. On the multivariate analysis, there was a borderline significant relationship between a fever and the prothrombin time-International Normalized Ratio (p=0.065), likely reflecting the extrinsic pathway activity initiated by tissue factor. Conclusion Our findings suggest that a fever in AAD could be caused by SIRS, provoked by endogenous mediators that influence the extrinsic coagulation pathway without elevating the serum procalcitonin concentration. PMID:27432091

  13. [Therapeutical effects of pleural injecting recombinant human endostain to 
malignant pleural effusion nude mice model].

    PubMed

    Zhou, Ming; Li, Min; Yang, Huaping; Hu, Chengping

    2015-05-01

    背景与目的 恶性胸腔积液(malignant pleural effusion, MPE)临床预后不佳,胸腔内抗血管治疗可能对恶性胸腔积液具有治疗作用,本研究旨在探讨胸腔内注射重组人血管内皮抑素、顺铂、重组人血管内皮抑素联合顺铂对裸鼠恶性胸腔积液的治疗作用。方法 BALB/c裸鼠胸膜腔内注射Lewis肺癌细胞(Lewis lung cancer cell, LCC)构建恶性胸腔积液模型,造模后分别胸腔内注射重组人血管内皮抑素(E)、顺铂(P)以及重组人血管内皮抑素联合顺铂(EP)并分析各组裸鼠胸腔积液量、胸膜肿瘤微血管密度(micro vessel density, MVD)以及血管生成、凋亡相关基因的表达变化。结果 重组人血管内皮抑素及重组人血管内皮抑素联合顺铂胸腔内注射可以使裸鼠MPE量减少,且与裸鼠胸腔肿瘤组织MVD下降呈正相关;且重组人血管内皮抑素及重组人血管内皮抑素联合顺铂胸腔内注射后,MPE裸鼠胸腔肿瘤组织血管内皮生长因子(Vescular epidermal growth factor-α, VEGF-α)表达下降、低氧诱导因子-α(hypoxia induced factor-1, HIF1-α)表达升高。结论 胸腔内注射LLC细胞可成功制作裸鼠MPE模型。重组人血管内皮抑素裸鼠胸膜腔内注射对MPE裸鼠具有治疗作用,其治疗作用可能是通过下调VEGF-α,抑制肿瘤新生血管生成,下调微血管密度而达成的。.

  14. Journal Article: Localized Pleural Thickening: Smoking and Exposure to Libby Vermiculite

    EPA Science Inventory

    There is limited research on the combined effects of smoking and asbestos exposure on risk of localized pleural thickening (LPT). This analysis uses data from the Marysville cohort of workers occupationally exposed to Libby amphibole asbestos (LAA). Workers were interviewed to ...

  15. Pleural plaques related to “take-home” exposure to asbestos: An international case series

    PubMed Central

    Peretz, Alon; Van Hee, Victor C; Kramer, Mordechai R; Pitlik, Silvio; Keifer, Matthew C

    2008-01-01

    Context: While a large number of studies indicate the risks of high-level exposures to asbestos in the workplace setting, a relatively small number of studies describe the risk of pleural disease related to “take-home” asbestos brought into the household by workers exposed to asbestos. Consequently, the risk of pleural disease in family members of asbestos-exposed workers is likely underappreciated. Case presentations: Two families of siblings, one in Israel and one in the US, were evaluated because of their significant exposures to asbestos brought into the home by family members with heavy occupational exposures. Two of the four children of an asbestos cement debagger in Petach Tikvah, Israel and two children of a pipe lagger in a naval shipyard near Seattle, Washington, manifested benign pleural disease without parenchymal disease, despite having no occupational exposure to asbestos. Discussion: These cases illustrate that “take-home” asbestos exposure may lead to pleural disease at higher rates than commonly realized. Relevance to clinical practice: Providers should recognize that due to the potential for “take-home” exposures, asbestos-related disease in a patient may be a marker for disease in household contacts. Patients with family members heavily exposed to asbestos should be strongly encouraged to quit smoking in an effort to reduce any further carcinogenic exposures. Additionally, workplace control and regulation of asbestos use should be emphasized to protect both workers and their families. PMID:20428401

  16. Environmental exposure to asbestos and risk of pleural mesothelioma: review and meta-analysis.

    PubMed

    Bourdès, V; Boffetta, P; Pisani, P

    2000-05-01

    A number of epidemiological studies have addressed the risk of pleural mesothelioma from environmental (household and neighborhood) exposure to asbestos, but no overall risk estimate is available. We reviewed the epidemiological studies on risk of pleural mesothelioma and household or neighborhood exposure to asbestos. We identified eight relevant studies; most were conducted in populations with relatively high exposure levels. We combined the risk estimates in a meta-analysis based on the random-effects model. The relative risks (RRs) of pleural mesothelioma for household exposure ranged between 4.0 and 23.7, and the summary risk estimate was 8.1 (95% confidence interval [CI]: 5.3-12). For neighborhood exposure, RRs ranged between 5.1 and 9.3 (with a single RR of 0.2) and the summary estimate was 7.0 (95% CI: 4.7-11). This review suggests a substantial increase in risk of pleural mesothelioma following high environmental exposure to asbestos; however, the available data are insufficient to estimate the magnitude of the excess risk at the levels of environmental exposure commonly encountered by the general population in industrial countries.

  17. Helical tomotherapy for resected malignant pleural mesothelioma: dosimetric evaluation and toxicity.

    PubMed

    Giraud, Philippe; Sylvestre, Alma; Zefkili, Sofia; Lisbona, Albert; Bonnette, Pierre; Le Pimpec Barthes, Françoise; Paris, Edouard; Perigaud, Christian; Savignoni, Alexia; Mahé, Marc-André

    2011-11-01

    This study evaluated adjuvant helical tomotherapy after extrapleural pneumonectomy ± neo-adjuvant chemotherapy in 24 patients with malignant pleural mesothelioma. Toxicity was judged acceptable despite 2 cases (8%) of suspected grade 5 pneumonitis. With a mean follow-up of 7 months, 5 patients had distant and 2 local and distant failure.

  18. Survival of pleural malignant mesothelioma in Italy: a population-based study.

    PubMed

    Montanaro, Fabio; Rosato, Rosalba; Gangemi, Manuela; Roberti, Sara; Ricceri, Fulvio; Merler, Enzo; Gennaro, Valerio; Romanelli, Antonio; Chellini, Elisabetta; Pascucci, Cristiana; Musti, Marina; Nicita, Carmela; Barbieri, Pietro Gino; Marinaccio, Alessandro; Magnani, Corrado; Mirabelli, Dario

    2009-01-01

    A median survival time of about 9 months is generally reported among malignant pleural mesothelioma cases. Recently, better results in terms of survival and performance status have been reported in clinical trials that included highly selected patients. We describe the survival of pleural mesothelioma patients and the factors predictive of survival in an unselected, population-based setting. Pleural mesothelioma cases (4,100) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were carried out according to selected individual characteristics, including limited information on treatment in a subset of 578 cases. The median survival time was 9.8 months (95% confidence interval: 9.4-10.1). In multivariate analysis, younger age at diagnosis and epithelioid histotype were associated with significantly reduced hazard ratios. Positive effects of gender (women) and being diagnosed in a hospital with a thoracic surgery unit were of border-line statistical significance. No association with calendar period of diagnosis or asbestos exposure was present. Treatment was not associated with a statistically significant improvement in survival. This is the largest population-based study on survival in patients with pleural mesothelioma to date. Age and morphology were the main prognostic factors. Results regarding the effect of treatment were disappointing but may be useful to assess the future impact, at the population level, of recently introduced therapies.

  19. Video Assisted Rigid Thoracoscopy in the Diagnosis of Unexplained Exudative Pleural Effusion

    PubMed Central

    Beheshtirouy, Samad; Kakaei, Farzad; Mirzaaghazadeh, Mohammad

    2013-01-01

    Introduction: An undiagnosed exudative pleural effusion is often a difficult diagnostic dilemma that needs further histological study for a definitive etiological diagnosis. Video assisted rigid thoracoscopy is a minimally invasive procedure with a minor morbidity and mortality risk that could resolve this problem. Methods: Between January 2010 and December 2011, we performed thoracoscopy in 26 patients for diagnosis of undiagnosed exudative pleural effusion. Clinical and paraclinical data of patients were collected prospectively and analyzed. Results: Sole pleural effusion was the most common CT scan finding seen in 17 (65.4%) patients. Thoracoscopy was diagnostic in 24 patients (92.3%). The pathologic findings were carcinoma (46.2%), tuberculosis (30.8%) and chronic inflammation without a definitive microbiologic culture (15.4%). Surprisingly mean ADA level in the tuberculosis group was in normal range. No mortality or complication related to our operation was observed. Conclusion: Video assisted thoracoscopy is a minimally invasive procedure with a high definitive diagnostic accuracy in the evaluation of tuberculosis and malignant pleural effusions. Pulmonologist should refer these patients sooner to decrease the waiting period of diagnosis and treatment of such conditions. PMID:24252982

  20. Marked effect of octreotide acetate in a case of pancreatic pleural effusion.

    PubMed

    Takeo, C; Myojo, S

    2000-01-01

    A pancreaticopleural effusion is a rare complication of chronic pancreatitis. Fasting, a protease inhibitor, and/or a surgical intervention are generally selected for the treatment of the pancreatic effusion. We reported here the case, in which octreotide acetate was effective for resolving pancreatic effusion. A 67-year-old man was admitted with a massive pleural effusion. This effusion contained a high level of amylase. Endoscopic retrograde pancreatography followed by computed tomography revealed a pancreaticopleural fistula. The pleural effusion was not improved by the treatment of the protease inhibitor with total parenteral nutrition and fasting. A pancreatic stent could not be emplaced because the major pancreatic duct was coiled. Administration of octreotide acetate, a long-acting somatostatin analogue, markedly diminished the effusion and closed the pancreaticopleural fistula. Transient eosinophilia of peripheral blood was seen on admission, but the number of eosinophils decreased after the octreotide therapy and normalised when pleural effusion disappeared. Octreotide is one of the effective options for the treatment of pancreatic pleural effusion.

  1. Interventional therapies for malignant pleural effusions: the present and the future.

    PubMed

    Thomas, Rajesh; Francis, Roslyn; Davies, Helen E; Lee, Y C Gary

    2014-08-01

    The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials. Efforts to minimize patient morbidity are complemented by development of less invasive treatments that have mostly replaced the more aggressive surgical approaches of the past. Therapeutic thoracentesis is simple, effective and generally safe, although its benefits may only be temporary. Pleurodesis is the conventional and for a long time the only definitive therapy available. However, the efficacy and safety of talc pleurodesis has been challenged. Indwelling pleural catheter (IPC) drainage is increasingly accepted worldwide and represents a new concept to improve symptoms without necessarily generating pleural symphysis. Recent studies support the effectiveness of IPC treatment and provide reassurance regarding its safety. An unprecedented number of clinical trials are now underway to improve various aspects of MPE care. However, choosing an optimal intervention for MPE in an individual patient remains a challenge due to our limited understanding of the underlying pathophysiology of breathlessness in MPE and a lack of predictors of survival and pleurodesis outcome. This review provides an overview of common pleural interventional procedures used for MPE management, controversies and limitations of current practice, and areas of research most needed to improve practice in future.

  2. [Current opinion on the features of pleural effusions with various genesis].

    PubMed

    Podgurskaia, E P

    2008-01-01

    Clinical features of not high-specific pleural effusions (PE) with various aetiology are considered. Based on state-of-the-art laboratory-instrumental methods some clinicalfeatures established: parapneumonic PE were characterized by acute onset, tuberculous PE more frequently had cubacute course, tumourous PE were characterized by gradual development with consequent symptoms.

  3. Pleural thickening in a construction worker: it is not always mesothelioma.

    PubMed

    Saboerali, M D; Koolen, M G J; Noorduyn, L A; van Delden, O M; Bogaard, H J

    2006-03-01

    We describe the case of a 45-year-old man presenting with chest pain and pleural effusions. These symptoms were progressive over a period of three years, with pericardial involvement and respiratory insufficiency finally resulting in death. Despite repeated diagnostic procedures, a final diagnosis could only be made at autopsy. Multisystem foamy histiocyte infiltration suggested the diagnosis of Erdheim-Chester disease.

  4. Three-dimensional automatic computer-aided evaluation of pleural effusions on chest CT images

    NASA Astrophysics Data System (ADS)

    Bi, Mark; Summers, Ronald M.; Yao, Jianhua

    2011-03-01

    The ability to estimate the volume of pleural effusions is desirable as it can provide information about the severity of the condition and the need for thoracentesis. We present here an improved version of an automated program to measure the volume of pleural effusions using regular chest CT images. First, the lungs are segmented using region growing, mathematical morphology, and anatomical knowledge. The visceral and parietal layers of the pleura are then extracted based on anatomical landmarks, curve fitting and active contour models. The liver and compressed tissues are segmented out using thresholding. The pleural space is then fitted to a Bezier surface which is subsequently projected onto the individual two-dimensional slices. Finally, the volume of the pleural effusion is quantified. Our method was tested on 15 chest CT studies and validated against three separate manual tracings. The Dice coefficients were 0.74+/-0.07, 0.74+/-0.08, and 0.75+/-0.07 respectively, comparable to the variation between two different manual tracings.

  5. [Treatment of malignant pleural effusion by percutaneous catheter drainage and chemical pleurodesis].

    PubMed

    Chella, A; Ribechini, A; Dini, P; Adamo, C; Mussi, A; Angeletti, C A

    1994-11-01

    From June 1989 to December 1991, 93 patients affected by malignant pleural effusion (MPE) were treated as out patients using a ultrasound (US) guided catheter drainage (10F Percuflex pig-tail catheter-Medi-tech@(PTC) and chemical pleurodesis. The PTC was positioned when the MPE had been diagnosed by X-ray and all the patients had undergone some thoracentesis (mean 3.2, range 2-6). We started a chemical pleurodesis when the MPE was inferior to 100cc/day injecting Epidoxorubicin (EDX 30 mg/mq) in the pleural space on alternate day for three administrations, and then, a lyophilized Corynebacterium Parvum (Wellcome strain CN 6134) (CBP 14 mg) on alternate day for two administrations. The complete response rate of this treatment was 90% (86 pt) with a mean treatment period of 32.9 days (range 12-62). Complete response was assessed as total resolution of pleural effusion. Side effects were short-term hyperpyrexia in 65 cases (69.8%) and pleurodynia in 15 cases (15.7%). Three patients (3.1%) were complicated by a pleural infection which was resolved in 1 case and became chronic in 2. These findings indicate that this technique is an adequate treatment for the control of MPE inducing a clinical and quality-life improvement. PMID:7708227

  6. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis.

    PubMed

    Tremblay, A; Mason, C; Michaud, G

    2007-10-01

    The aim of the present study was to examine the effectiveness of tunnelled pleural catheters (TPC) in patients with malignant pleural effusions who would otherwise be candidates for pleurodesis. Patients were selected from a previously reported database of 250 TPC insertions. The study group was selected based on lung re-expansion and survival as a surrogate maker of eligibility for pleurodesis procedure, as defined by survival of > or =90 days and lung re-expansion > or =80% post-drainage on a standard chest radiograph 2 weeks post TPC placement. There were 109 procedures in 97 patients that met the entry criteria. Spontaneous pleurodesis (SP) was achieved following 70% of procedures and correlated with symptom control. The mean time to SP was 90 days. There was no need for a repeat procedure in 87% of cases overall and in 92% of patients experiencing SP. There were few complications and no procedure-related deaths. Tunnelled pleural catheters are an effective way of controlling malignant pleural effusions when used as first-line treatment in patients who appear to be candidates for pleurodesis procedures. PMID:17567670

  7. Size- and shape-dependent pleural translocation, deposition, fibrogenesis, and mesothelial proliferation by multiwalled carbon nanotubes.

    PubMed

    Xu, Jiegou; Alexander, David B; Futakuchi, Mitsuru; Numano, Takamasa; Fukamachi, Katsumi; Suzui, Masumi; Omori, Toyonori; Kanno, Jun; Hirose, Akihiko; Tsuda, Hiroyuki

    2014-07-01

    Multiwalled carbon nanotubes (MWCNT) have a fibrous structure similar to asbestos, raising concern that MWCNT exposure may lead to asbestos-like diseases. Previously we showed that MWCNT translocated from the lung alveoli into the pleural cavity and caused mesothelial proliferation and fibrosis in the visceral pleura. Multiwalled carbon nanotubes were not found in the parietal pleura, the initial site of development of asbestos-caused pleural diseases in humans, probably due to the short exposure period of the study. In the present study, we extended the exposure period to 24 weeks to determine whether the size and shape of MWCNT impact on deposition and lesion development in the pleura and lung. Two different MWCNTs were chosen for this study: a larger sized needle-like MWCNT (MWCNT-L; l = 8 μm, d = 150 nm), and a smaller sized MWCNT (MWCNT-S; l = 3 μm, d = 15 nm), which forms cotton candy-like aggregates. Both MWCNT-L and MWCNT-S suspensions were administered to the rat lung once every 2 weeks for 24 weeks by transtracheal intrapulmonary spraying. It was found that MWCNT-L, but not MWCNT-S, translocated into the pleural cavity, deposited in the parietal pleura, and induced fibrosis and patchy parietal mesothelial proliferation lesions. In addition, MWCNT-L induced stronger inflammatory reactions including increased inflammatory cell number and cytokine/chemokine levels in the pleural cavity lavage than MWCNT-S. In contrast, MWCNT-S induced stronger inflammation and higher 8-hydroxydeoxyguanosine level in the lung tissue than MWCNT-L. These results suggest that MWCNT-L has higher risk of causing asbestos-like pleural lesions relevant to mesothelioma development.

  8. An age, period and cohort analysis of pleural cancer mortality in Europe.

    PubMed

    La Vecchia, C; Decarli, A; Peto, J; Levi, F; Tomei, F; Negri, E

    2000-06-01

    Death certification data from pleural cancer in eight European countries providing data to the World Health Organization database over the period 1970-1994 were analysed using a log-linear Poisson model to disentangle the effects of age, birth cohort and period of death. The age effect reached values between 10 and 15/100,000 males at age 80-84 in most countries, except Hungary (6.7), Switzerland (18.0), France (20.6) and the Netherlands (36.5). Cohort effects were steadily and appreciably upwards in all countries up to the generations born in 1940 or 1945, and levelled off for the 1950 cohort, except in Hungary, where persistent rises were observed. Thus, most rises in pleural cancer mortality in Europe were on a cohort of birth basis. Since most pleural cases were asbestos-related mesotheliomas, and since asbestos has an early-stage effect on subsequent mesothelioma risk, exposure early in life is important for determining the subsequent mesothelioma risk of each generation. Consequently, the data indicate that the peak mortality from pleural cancer in most western European countries will be reached in the first decades of the 21st century, i.e. around 2010-2020, when the generations born between 1940 and 1950 will reach the peak age for mesothelioma incidence and mortality. This contrasts with US data, where the peak of pleural cancer incidence has been reached at the end of the 20th century, and reflects a delay in adopting adequate prevention measures since the 1940-1945 generations entered the workforce in the 1960s, when cancer risk from asbestos exposure was already recognized.

  9. Pleural and peritoneal mesotheliomas in SEER: age effects and temporal trends, 1973-2005.

    PubMed

    Moolgavkar, Suresh H; Meza, Rafael; Turim, Jay

    2009-08-01

    We analyzed mesothelioma incidence in the Surveillance, Epidemiology, and End Results (SEER) database over the period 1973-2005 using extensions of the age-period-cohort (APC) models. In these analyses, the usual non-specific age effects of the conventional APC models were replaced by hazard functions derived from two multistage models of carcinogenesis, the Armitage-Doll model and the two-stage clonal expansion (TSCE) model. The extended APC models described the incidence data on pleural and peritoneal mesotheliomas well. After adjustment for temporal trends, the data suggest that the age-specific incidence rates of both pleural and peritoneal mesotheliomas are identical in men and women. Driven largely by birth cohort effects, age-adjusted rates of pleural mesothelioma among men rose from about 7.5 per million person-years in 1973 to about 20 per million person-years in the early 1990s and appear to be stable or declining thereafter. Age-adjusted rates of pleural mesothelioma among women have remained more or less constant at about 2.5 per million person-years over the period 1973-2005. Age-adjusted rates for peritoneal mesothelioma in both men (1.2 per million person-years) and women (0.8 per million person-years) exhibit no temporal trends over the period of the study. We estimate that approximately 94,000 cases of pleural and 15,000 cases of peritoneal mesothelioma will occur in the US over the period 2005-2050.

  10. Translocation of particles to the pleural space and tracheobronchial lymph nodes following lung deposition

    SciTech Connect

    Lehnert, B.E.; Valdez, Y.E.; Hyler, S.

    1985-01-01

    The translocation of particles from the alveolar compartment to the pleural space and tracheobronchial lymph nodes was investigated in rats over a 30 day period following the intrapulmonary instillation of 4 x 10/sup 8/ polystyrene microspheres (1.9 ..mu..m dia.). In initial studies, approx. =10/sup 4/ particles were found in the pleural space compartment on Days 1, 14 and 30 after particle deposition, and most of these were cell-associated. Subsequent pleural space studies indicated, however, that the particles found in this compartment were, at least in part, due to the pleural lavage technique, and, unlike observations reported for some fibers, the translocation of the particles used in our study to the pleural space does not represent an important lung clearance pathway. In regard to particle clearance to the tracheobronchial lymph nodes, the accumulation of particles, most of which were extracellular, kinetically was biphasic with the most rapid phase occurring within the first 24 hours. Over the Day 1-30 period, the numbers of particles in the lymph nodes increased linearly to approx. =1.2 x 10/sup 6/ microspheres. The percentages of the nodal particles that were associated with nodal mononuclear phagocytes (NMP) over the course of the study were inversely proportional to nodal particulate burdens, even though the percentage of cells with engulfed particles increased; the percentage of NMP asymptotically approached a maximum value over the range of nodal burden of 6-12 x 10/sup 5/ particles. The distributions of the microspheres in the NMP were essentially identical on Days 1, 14, and 30. Major differences in the distributions of particles in lavage alveolar macrophages and NMP were not consistent with the notion that the latter represented translocated AM. 20 refs., 7 figs., 4 tabs.

  11. Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020

    PubMed Central

    2013-01-01

    Background A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011–2015 and 2016–2020 in Spain. Methods Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions. Results Pleural cancer deaths increased across the study period, rising from 491 in 1976–1980 to 1,249 in 2006–2010. Predictions for the five-year period 2016–2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality. Conclusion The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040. PMID:24195451

  12. An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia.

    PubMed Central

    Baris, Y I; Sahin, A A; Ozesmi, M; Kerse, I; Ozen, E; Kolacan, B; Altinörs, M; Göktepeli, A

    1978-01-01

    The 575 inhabitants of the remote Anatolian village of Karain suffered 11 deaths from pleural mesothelioma in 1975/76 and there were five cases of fibrosing pleurisy. In the previous five years there had been 25 cases of mesothelioma. Calcified pleural plaques were common on survey radiography. Asbestos does not occur in the local soil or rock, nor is it handled in the village, but a few fibres were found in the water. Fibres were also found in the pleural tissue of two of five cases examined. Inhabitants of the neighbouring villages are free of mesothelioma. Images PMID:663877

  13. The Effect of Pleural Abrasion on the Treatment of Primary Spontaneous Pneumothorax: A Systematic Review of Randomized Controlled Trials

    PubMed Central

    Ming, Mo-yu; Cai, Shuang-qi; Chen, Yi-Qiang

    2015-01-01

    Background Pleural abrasion has been widely used to control the recurrence of primary spontaneous pneumothorax (PSP). However, controversy still exists regarding the advantages and disadvantages of pleural abrasion compared with other interventions in preventing the recurrence of PSP. Methods The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to December 15, 2014 to identify randomized controlled trials (RCTs) that compared the effects of pleural abrasion with those of other interventions in the treatment of PSP. The study outcomes included the PSP recurrence rate and the occurrence rate of adverse effects. Results Mechanical pleural abrasion and apical pleurectomy after thoracoscopic stapled bullectomy exhibited similarly persistent postoperative air leak occurrence rates (p = 0.978) and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led to reduced residual chest pain and discomfort (p = 0.001) and a smaller rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the addition of minocycline pleurodesis to pleural abrasion did not reduce the pneumothorax recurrence rate compared with apical pleurectomy (3.8% for both procedures) but was associated with fewer complications. There was no statistical difference in the pneumothorax recurrence rate between mechanical pleural abrasion and chemical pleurodesis with minocycline on either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12; Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24; Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did not reduce the pneumothorax recurrence rate compared with pleural abrasion alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis was associated with more intense acute chest pain. The postoperative overall recurrence rate in patients who underwent staple line coverage with absorbable cellulose mesh and fibrin glue was similar to that

  14. Correlations between EGFR gene polymorphisms and pleural metastasis of lung adenocarcinoma

    PubMed Central

    Guo, Haisheng; Xing, Yunhui; Mu, Ailan; Li, Xia; Li, Tingshan; Bian, Xia; Yang, Chunmei; Zhang, Xiaolei; Liu, Yuefen; Wang, Xunguo

    2016-01-01

    Proliferation, growth, and differentiation of cells are strictly controlled by the signal system of epidermal growth factor receptor (EGFR). If any link of the EGFR signals system is interfered with or damaged, the proliferation, growth, and differentiation of cells would become uncontrolled. EGFR is overexpressed in a variety of malignant tumors, such as non-small-cell lung cancer, colorectal cancer and breast cancer. Results of the study have proved that EGFR overexpression is closely associated with mutations and variants of the EGFR genes, whose mutations and variants are associated with occurrence, metastasis, and prognosis of different types of tumors, including lung cancer. This study is aimed at investigating whether the polymorphisms of CA simple sequence repeat in intron 1 (CA-SSR1), -216G/T, and R497K in the EGFR are able to induce EGFR activation and whether overexpression is associated with pleural metastasis of lung adenocarcinoma. A total of 432 lung adenocarcinoma patients with pleural metastasis (metastasis group) and 424 patients with lung adenocarcinoma but without pleural metastasis (nonmetastasis group) were enrolled in this study. For all patients, the CA-SSR1 genotypes were determined by capillary electrophoresis, polymerase chain reaction amplification, and direct DNA sequencing, and the R497K and -216G/T genotypes were determined by polymerase chain reaction amplification and direct DNA sequencing. EGFR expression was evaluated by immunohistochemical staining in primary tumor tissues with different -216G/T, R497K, and CA-SSR1 genotypes. Our results showed significant differences between pleural metastasis and nonmetastasis groups in the genotype and allele distribution of -216G/T, R497K, and CA-SSR1 polymorphisms of the EGFR gene. The -216T allele, Arg allele, and shorter CA-SSR1 (<17) had significantly increased risks of pleural metastasis compared with the -216G allele, Lys allele, and longer CA-SSR1 (≥17), respectively. The expression

  15. Correlations between EGFR gene polymorphisms and pleural metastasis of lung adenocarcinoma

    PubMed Central

    Guo, Haisheng; Xing, Yunhui; Mu, Ailan; Li, Xia; Li, Tingshan; Bian, Xia; Yang, Chunmei; Zhang, Xiaolei; Liu, Yuefen; Wang, Xunguo

    2016-01-01

    Proliferation, growth, and differentiation of cells are strictly controlled by the signal system of epidermal growth factor receptor (EGFR). If any link of the EGFR signals system is interfered with or damaged, the proliferation, growth, and differentiation of cells would become uncontrolled. EGFR is overexpressed in a variety of malignant tumors, such as non-small-cell lung cancer, colorectal cancer and breast cancer. Results of the study have proved that EGFR overexpression is closely associated with mutations and variants of the EGFR genes, whose mutations and variants are associated with occurrence, metastasis, and prognosis of different types of tumors, including lung cancer. This study is aimed at investigating whether the polymorphisms of CA simple sequence repeat in intron 1 (CA-SSR1), -216G/T, and R497K in the EGFR are able to induce EGFR activation and whether overexpression is associated with pleural metastasis of lung adenocarcinoma. A total of 432 lung adenocarcinoma patients with pleural metastasis (metastasis group) and 424 patients with lung adenocarcinoma but without pleural metastasis (nonmetastasis group) were enrolled in this study. For all patients, the CA-SSR1 genotypes were determined by capillary electrophoresis, polymerase chain reaction amplification, and direct DNA sequencing, and the R497K and -216G/T genotypes were determined by polymerase chain reaction amplification and direct DNA sequencing. EGFR expression was evaluated by immunohistochemical staining in primary tumor tissues with different -216G/T, R497K, and CA-SSR1 genotypes. Our results showed significant differences between pleural metastasis and nonmetastasis groups in the genotype and allele distribution of -216G/T, R497K, and CA-SSR1 polymorphisms of the EGFR gene. The -216T allele, Arg allele, and shorter CA-SSR1 (<17) had significantly increased risks of pleural metastasis compared with the -216G allele, Lys allele, and longer CA-SSR1 (≥17), respectively. The expression

  16. Correlations between EGFR gene polymorphisms and pleural metastasis of lung adenocarcinoma.

    PubMed

    Guo, Haisheng; Xing, Yunhui; Mu, Ailan; Li, Xia; Li, Tingshan; Bian, Xia; Yang, Chunmei; Zhang, Xiaolei; Liu, Yuefen; Wang, Xunguo

    2016-01-01

    Proliferation, growth, and differentiation of cells are strictly controlled by the signal system of epidermal growth factor receptor (EGFR). If any link of the EGFR signals system is interfered with or damaged, the proliferation, growth, and differentiation of cells would become uncontrolled. EGFR is overexpressed in a variety of malignant tumors, such as non-small-cell lung cancer, colorectal cancer and breast cancer. Results of the study have proved that EGFR overexpression is closely associated with mutations and variants of the EGFR genes, whose mutations and variants are associated with occurrence, metastasis, and prognosis of different types of tumors, including lung cancer. This study is aimed at investigating whether the polymorphisms of CA simple sequence repeat in intron 1 (CA-SSR1), -216G/T, and R497K in the EGFR are able to induce EGFR activation and whether overexpression is associated with pleural metastasis of lung adenocarcinoma. A total of 432 lung adenocarcinoma patients with pleural metastasis (metastasis group) and 424 patients with lung adenocarcinoma but without pleural metastasis (nonmetastasis group) were enrolled in this study. For all patients, the CA-SSR1 genotypes were determined by capillary electrophoresis, polymerase chain reaction amplification, and direct DNA sequencing, and the R497K and -216G/T genotypes were determined by polymerase chain reaction amplification and direct DNA sequencing. EGFR expression was evaluated by immunohistochemical staining in primary tumor tissues with different -216G/T, R497K, and CA-SSR1 genotypes. Our results showed significant differences between pleural metastasis and nonmetastasis groups in the genotype and allele distribution of -216G/T, R497K, and CA-SSR1 polymorphisms of the EGFR gene. The -216T allele, Arg allele, and shorter CA-SSR1 (<17) had significantly increased risks of pleural metastasis compared with the -216G allele, Lys allele, and longer CA-SSR1 (≥17), respectively. The expression

  17. [Efficacy of octreotide acetate in the treatment of a pancreatic-pleural fistula. Apropos of a case].

    PubMed

    Courtin, J P; Di Francia, M; Poubeau, P; Arvin-Berod, C

    1994-01-01

    Diseases organs below the diaphragm should be considered in the aetiologic diagnosis of liquid effusion in the pleura. We observed a cases of pleuritis resulting from chronic pancreatitis and present here the diagnostic methods and therapeutic protocol undertake for cure. The level of amylase (including the isoforms) should be measured in the pleural effusion. The effectiveness of octreotide acetate in the treatment of pancreatico-pleural fistula was confirmed in this case.

  18. Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses.

    PubMed

    Bourbeau, J; Ernst, P

    1988-01-01

    Although there are published data concerning reader variability in the assessment of parenchymal pneumoconiotic changes using the ILO Classification of Radiographs, nothing has been published on reader variability with regard to pleural abnormalities. Therefore, in the context of an epidemiologic study, we assessed between- and within-reader variability in the reading of chest radiographs for pleural abnormality using the ILO 1980 International Classification of Radiographs of Pneumoconioses. Chest radiographs of 182 insulation workers interspersed with 24 subjects without documented exposure to asbestos were assembled and read blindly by two readers, reading separately on two occasions, 1 week apart. The results of this study suggest that confident separation of pleural plaques and diffuse pleural thickening may be difficult to achieve using the present guidelines of the ILO 1980 classification. In the evaluation of the width of chest wall pleural abnormality, within-reader agreement improves as the width increases, while between-reader agreement was much less satisfactory. Excellent agreement is obtained in the evaluation of other sites, especially costophrenic angle obliteration and the presence of pleural calcification.

  19. Predictors of survival in patients who underwent video‐assisted thoracic surgery talc pleurodesis for malignant pleural effusion

    PubMed Central

    Yoon, Dong Woog; Choi, Yong Soo; Kim, Jhingook; Kim, Hong Kwan; Zo, Jae Ill; Shim, Young Mog

    2016-01-01

    Background Patients with malignant pleural effusion have a limited life expectancy. An increase in pleural and oncological treatment options and more accurate prognostic evaluation may help individualize treatment strategies. The aim of this study was to identify the prognostic indicators of overall survival (OS) after video‐assisted thoracic surgery (VATS) talc pleurodesis for malignant pleural effusion. Methods We examined the medical records of all consecutive patients with malignant pleural effusion who underwent VATS talc pleurodesis from 2006 to 2008 at the Samsung Medical Center. Univariate and multivariate analyses were used to identify predictors of OS after VATS talc pleurodesis. Results During the study period, 91 patients underwent VATS talc pleurodesis to treat malignant pleural effusion. Early (within 30 days) and late (within 90 days) postoperative mortality rates were 9.9% (9 patients), and 25.3% (23), respectively. Median survival time after VATS talc pleurodesis was 10.5 months. The postoperative respiratory complication rate was 11% (10 patients), and included pneumonia (9) and acute respiratory distress syndrome (4). Multivariate analysis revealed that preoperative chemotherapy (P = 0.012), preoperative radiotherapy (P = 0.003), and Eastern Cooperative Oncology Group (ECOG) performance score 3 or 4 (P = 0.013) were independent risk factors of OS after VATS talc pleurodesis. Conclusions We identified previous chemotherapy or radiotherapy and poor performance status (ECOG 3 or 4) as significant predictors of OS after VATS talc pleurodesis. These prognostic factors can help surgeons select candidates for VATS pleurodesis for malignant pleural effusion. PMID:27385980

  20. Pleural Covering Application for Recurrent Pneumothorax in a Patient with Birt-Hogg-Dubé Syndrome

    PubMed Central

    Otsuji, Mizuto; Mizobuchi, Teruaki; Kurihara, Masatoshi; Takahashi, Kazuhisa; Seyama, Kuniaki

    2015-01-01

    Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary disease that presents with multiple lung cysts and recurrent pneumothorax. These cysts occupy predominantly the lower-medial zone of the lung field adjacent to the interlobar fissure, and some of them abut peripheral pulmonary vessels. For the surgical management of pneumothorax with BHDS, the conventional approach of resecting all subpleural cysts and bullae is not feasible. Thus, after handling several bullae by using a stapler or performing ligation as a standardized treatment, we applied to a pleural covering technique to thicken the affected visceral pleura and then to prevent recurrence of pneumothorax. We herein report the successful application of a pleural covering technique via thoracoscopic surgery to treat the recurrent pneumothorax of a 30-year-old man with BHDS. This technique is promising for the management of intractable pneumothorax secondary to BHDS. PMID:26370712