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Shehata SM, Almalki YE, Basha MAA, Hendy RM, Mahmoud EM, Abd Elhamed ME, Alduraibi SK, Aboualkheir M, Almushayti ZA, Alduraibi AK, Basha AMA, Alsadik ME. Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study. Diagnostics (Basel) 2024; 14:1041. [PMID: 38786339 PMCID: PMC11120087 DOI: 10.3390/diagnostics14101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.
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Affiliation(s)
- Samah M. Shehata
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Rasha Mohamed Hendy
- Department of Chest Disease, Faculty of Human Medicine, Benha University, Benha 13511, Egypt;
| | - Eman M. Mahmoud
- Department of Chest Disease, Faculty of Human Medicine, Port Said University, Port Said 42511, Egypt;
| | - Marwa Elsayed Abd Elhamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Mervat Aboualkheir
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Ziyad A. Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Alaa K. Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | | | - Maha E. Alsadik
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
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Zunzunwala S, Jaiswal PR. Effectiveness of Physiotherapy Interventions in Pleural Effusion Patients: A Comprehensive Review. Cureus 2024; 16:e61195. [PMID: 38939282 PMCID: PMC11210338 DOI: 10.7759/cureus.61195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Pleural effusion, characterized by the accumulation of fluid between the parietal and visceral pleura, presents significant challenges in patient management, particularly in cases of malignant pleural effusion. Despite various therapeutic options, there is a need to evaluate the effectiveness of physiotherapy interventions specifically for pleural effusion patients, as current literature predominantly focuses on medical and surgical treatments. This comprehensive review aims to address this research gap by systematically analyzing the impact of physiotherapy on pleural effusion management, with a focus on symptom relief and improvement in quality of life. The objective is to determine the role of physiotherapy in reducing hospital stay and enhancing patient outcomes. Methodologically, this review synthesizes data from clinical studies and case reports that document physiotherapy interventions, such as breathing exercises, postural drainage, and mobilization techniques, in the treatment of pleural effusion. Our findings suggest that physiotherapy interventions can significantly alleviate dyspnoea and improve respiratory function, contributing to better overall patient outcomes. These results underscore the importance of incorporating physiotherapy into the standard care protocol for patients presenting with pleural effusion to optimize recovery and quality of life.
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Affiliation(s)
- Saurabh Zunzunwala
- Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik R Jaiswal
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Rocca E, Zanza C, Longhitano Y, Piccolella F, Romenskaya T, Racca F, Savioli G, Saviano A, Piccioni A, Mongodi S. Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review. Adv Respir Med 2023; 91:203-223. [PMID: 37218800 DOI: 10.3390/arm91030017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.
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Affiliation(s)
- Eduardo Rocca
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Tatsiana Romenskaya
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesia and Critical Care Medicine, AO Mauriziano Hospital, University of Turin, 10124 Turin, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Silvia Mongodi
- Department of Anesthesia and Intensive Care Medicine, Critical Care Unit-1, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy
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Fazli Khalaf F, Asadi Gharabaghi M, Balibegloo M, Davari H, Afshar S, Jahanbin B. Pleural CEA, CA-15-3, CYFRA 21-1, CA-19-9, CA-125 discriminating malignant from benign pleural effusions: Diagnostic cancer biomarkers. Int J Biol Markers 2023:3936155231158661. [PMID: 36942429 DOI: 10.1177/03936155231158661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION There is a need for a rapid, accurate, less-invasive approach to distinguishing malignant from benign pleural effusions. We investigated the diagnostic value of five pleural tumor markers in exudative pleural effusions. METHODS By immunochemiluminescence assay, we measured pleural concentrations of tumor markers. We used the receiver operating characteristic curve analysis to assess their diagnostic values. RESULTS A total of 281 patients were enrolled. All tumor markers were significantly higher in malignant pleural effusions than benign ones. The area under the curve of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, cytokeratin fragment 19 (CYFRA) 21-1, CA-19-9, and CA-125 were 0.81, 0.78, 0.75, 0.65, and 0.65, respectively. Combined markers of CEA + CA-15-3 and CEA + CA-15-3 + CYFRA 21-1 had a sensitivity of 87% and 94%, and specificity of 75% and 58%, respectively. We designed a diagnostic algorithm by combining pleural cytology with pleural tumor marker assay. CEA + CYFRA 21-1 + CA-19-9 + CA-15-3 was the best tumor markers panel detecting 96% of cytologically negative malignant pleural effusions, with a negative predictive value of 98%. CONCLUSIONS Although cytology is specific enough, it has less sensitivity in identifying malignant pleural fluids. As a result, the main gap is detecting malignant pleural effusions with negative cytology. CEA was the best single marker, followed by CA-15-3 and CYFRA 21-1. Through both cytology and suggested panels of tumor markers, malignant and benign pleural effusions could be truly diagnosed with an accuracy of about 98% without the need for more invasive procedures, except for the cohort with negative cytology and a positive tumor markers panel, which require more investigations.
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Affiliation(s)
- Farzaneh Fazli Khalaf
- Pathology Department, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Mehrnaz Asadi Gharabaghi
- Department of Pulmonary Medicine, Thoracic Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Balibegloo
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network, Chicago, IL, USA
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Davari
- General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Afshar
- Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Behnaz Jahanbin
- Pathology Department, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
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Sultan S, Gupta E, Benzaquen S. Management of complicated parapneumonic effusions. Curr Opin Pulm Med 2023; 29:54-59. [PMID: 36384805 DOI: 10.1097/mcp.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Approximately 36-57% of cases of pneumonia are associated with a parapneumonic effusion (PPE). It begins as sterile effusion, which can quickly evolve to a fibrinopurulent stage with evidence of infection called complicated parapneumonic effusions (CPPE). Marked fibrinous organization then follows. This study focuses on literature synthesis on management of CPPE. RECENT FINDINGS Ultrasound has become an indispensable tool in the identification and treatment of CPPE. Prompt antibiotic administration remains the universal standard of care. Decision to drain the fluid is based on fluid staging, characterization and assessment of risk of poor outcomes vs. risk of complications. There is growing evidence to support use of intrapleural fibrinolytic therapy (IPFT) in case of loculated effusions. Newer areas of research include antibodies against plasminogen activator inhibitors and stratification scores that can identify patients at an increased risk. Lastly, timing of surgical referral is an important area under study. SUMMARY Evolution of medical therapy over recent years has increased treatment success rates. Use of IPFT in conjunction to thoracostomy is now the standard of care for loculated effusions. Understanding available therapeutic options, both medical and interventional, can ensure evidence-based practice and improve patient-centred outcomes.
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Affiliation(s)
- Sahar Sultan
- Department of Pulmonary and Critical Care Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Ena Gupta
- Department of Pulmonary Medicine, University of Vermont, Burlington, Vermont
| | - Sadia Benzaquen
- Department of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
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Stecka AM, Grabczak EM, Michnikowski M, Zielińska-Krawczyk M, Krenke R, Gólczewski T. The impact of spontaneous cough on pleural pressure changes during therapeutic thoracentesis. Sci Rep 2022; 12:11502. [PMID: 35798822 PMCID: PMC9262881 DOI: 10.1038/s41598-022-15480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Cough during therapeutic thoracentesis (TT) is considered an adverse effect. The study was aimed to evaluate the relationship between cough during TT and pleural pressure (Ppl) changes (∆P). Instantaneous Ppl was measured after withdrawal of predetermined volumes of pleural fluid. Fluid withdrawal (FW) and Ppl measurement (PplM) periods were analyzed separately using the two sample Kolmogorov-Smirnov test and the nonparametric skew to assess differences between ∆P distributions in periods with and without cough. The study involved 59 patients, median age 66 years, median withdrawn fluid volume 1800 mL (1330 ÷ 2400 mL). In total, 1265 cough episodes were recorded in 52 patients, in 24% of FW and 19% of PplM periods, respectively. Cough was associated with significant changes in ∆P distribution (p < 0.001), decreasing the left tail of ∆P distribution for FW periods (the skew = - 0.033 vs. - 0.182) and increasing the right tail for PplM periods (the skew = 0.182 vs. 0.088). Although cough was more frequent in 46 patients with normal pleural elastance (p < 0.0001), it was associated with significantly higher ∆P in patients with elevated elastance (median Ppl increase 2.9 vs. 0.2 cmH2O, respectively). Cough during TT is associated with small but beneficial trend in Ppl changes, particularly in patients with elevated pleural elastance, and should not be considered solely as an adverse event.
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Affiliation(s)
- Anna M Stecka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109, Warsaw, Poland
| | - Elżbieta M Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland.
| | - Marcin Michnikowski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109, Warsaw, Poland
| | - Monika Zielińska-Krawczyk
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | - Tomasz Gólczewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109, Warsaw, Poland
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7
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Performance evaluation of UF-4000 body fluid mode for automated body fluid cell counting. Clin Chim Acta 2022; 531:152-156. [DOI: 10.1016/j.cca.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022]
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8
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Contribution of immature granulocyte level to diagnosis in pleural effusion. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:257-263. [PMID: 36168576 PMCID: PMC9473606 DOI: 10.5606/tgkdc.dergisi.2022.21523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/18/2021] [Indexed: 12/03/2022]
Abstract
Background
In this study, we aimed to evaluate the diagnostic value of neutrophil and immature granulocyte levels in peripheral blood in cases with pleural effusion.
Methods
Between May 2019 and May 2020, a total of 117 patients (43 males, 74 females; mean age: 63.1±18.1 years; range, 18 to 93 years) who had pleural effusion and analysis of pleural fluid were retrospectively analyzed. All patients were evaluated in terms of age, sex, presence of comorbid diseases, approach to the pleural fluid, biochemical values of peripheral blood and pleural fluid, hemogram series of peripheral blood, diagnosis of pleural fluid, and mortality.
Results
Of the patients, 66 (54.5%) were diagnosed with benign pleural effusion and 51 (43.5%) were diagnosed with malignant pleural effusion. Number of cases with known primary malignancy was 54 (46.1%). Immature granulocyte count number and percentage of venous blood in the malignant pleural effusion group was significantly higher than the group with benign pleural effusion (p<0.05).
Conclusion
As a hemogram parameter, immature granulocyte level is an easily applicable, cheap, and a non-invasive method in the outpatient settings.
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Sumer E, Hamitoglu M, Cumbul A, Ercan S, Bac N, Aydin A. Determination of In Vivo efficacy and safety of zeolite as a new pleurodesis agent. Toxicol Rep 2022; 9:1754-1765. [DOI: 10.1016/j.toxrep.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
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Chen L, Ma T, Wang L, Wang L, Li M, Zhu R. Unilateral pleural effusion secondary to Takayasu arteritis: a case report and literature review. J Biomed Res 2022; 36:141-144. [PMID: 35387904 PMCID: PMC9002159 DOI: 10.7555/jbr.36.20210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging from 14% to 86%, which can lead to pulmonary hypertension, a progressive increase in pulmonary artery pressure, and eventually death from right heart failure. The presentation of pulmonary arteritis (PA) is very nonspecific, with a reported misdiagnosis rate of up to 60% and a diagnosis time ranging from 1 month to more than 10 years. The clinical manifestation of pleural effusion is very rare in both TA and PA cases. Based on our literature review, this is the 6th reported case of TA with pleural effusion, and the specific mechanism of TA with pleural effusion is still unclear. The characteristics of this case and the previously reported cases are summarized in this article to improve the understanding of TA and PA and reduce the misdiagnosis rate.
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Affiliation(s)
- Ling Chen
- The Huai'an Clinical College of Xuzhou Medical University, Huai'an, Jiangsu 223300, China
| | - Ting Ma
- Department of Respiratory Medicine, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, China
| | - Liang Wang
- Department of Respiratory Medicine, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, China
| | - Lixin Wang
- Department of Respiratory Medicine, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, China
| | - Minmin Li
- Department of Respiratory Medicine, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, China
| | - Rong Zhu
- The Huai'an Clinical College of Xuzhou Medical University, Huai'an, Jiangsu 223300, China
- Rong Zhu, The Huai'an Clinical College of Xuzhou Medical University, 6 Beijing West Road, Huaiyin District, Huai'an City, Jiangsu Province 223300, China. Tel: +86-15152396158, E-mail:
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Perlepe G, Varsamas C, Petinaki E, Antonopoulos D, Daniil Z, Gourgoulianis KI. Discrimination of Exudative Pleural Effusions Based on Pleural Adenosine Deaminase (ADA)-C-Reactive Protein (CRP) Levels, and Their Combination: An Observational Prospective Study. J Pers Med 2021; 11:jpm11090864. [PMID: 34575641 PMCID: PMC8468238 DOI: 10.3390/jpm11090864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Malignant (MPE), parapneumonic (PPE) and tuberculous (TPE) pleural effusions constitute common causes of pleurisy. Discriminating among them is usually challenging. C-reactive protein (CRP) and adenosine deaminase (ADA) pleural levels (p-CRP, p-ADA) have been used as differentiators in many studies showing promising results. This study aims to evaluate the diagnostic value of p-CRP, p-ADA levels and their combination among the three categories. (2) Methods: A prospective study of 100 patients with MPE (n = 59), PPE (n = 34) and TPE (n = 7) from a single centre was performed. p-CRP levels were evaluated between PPE and non-PPE and between complicated (CPPE) and non-complicated PPE. ADA levels were also measured to classify patients among MPE and non- MPE. Eventually, the combination of p-CRP and p-ADA values was used as a discrimination factor among PPE, MPE and TPE. (3) Results: ROC analysis revealed that p-CRP with a cut-off value: 4.4 mg/dL can successfully differentiate PPE (AUC = 0.998). The cut-off level of 10 mg/dL can predict CPPE with sensitivity: 63%, specificity: 71.4%, positive predictive value (PPV): 89%, and negative predictive value (NPV): 33%. Furthermore, patients with ADA levels ≤ 32 U/L were more likely to belong to the malignant group sensitivity: 93%, specificity: 78%, PPV: 85.9%, and NPV: 88.9%. Discriminant analysis showed that the combination of p-CRP and p-ADA levels can discriminate PPE, MPE and TPE in 93% of cases. (4) Conclusion: This study provides evidence that p-CRP and p-ADA levels could be possibly used in clinal practice in order to establish a diagnosis among MPE, PPE and TPE.
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Affiliation(s)
- Garifallia Perlepe
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
- Correspondence: ; Tel.: +30-2413501613
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
| | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, 41110 Larissa, Greece;
| | - Dionysios Antonopoulos
- Department of Biochemistry and Biotechnology, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
| | - Konstantinos I. Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
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12
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Raji H, Hamid Borsi S, Dargahi MalAmir M, Asadollah Salmanpour AR. Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.
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Affiliation(s)
- Hanie Raji
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hamid Borsi
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrdad Dargahi MalAmir
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Asadollah Salmanpour
- Air Pollution, and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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13
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Wong T, Gold J, Houser R, Herschman Y, Jani R, Goldstein I. Ventriculopleural shunt: Review of literature and novel ways to improve ventriculopleural shunt tolerance. J Neurol Sci 2021; 428:117564. [PMID: 34242833 DOI: 10.1016/j.jns.2021.117564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
Cerebrospinal fluid (CSF) diversion is among the most commonneurosurgical procedures that are performed worldwide. It is estimated thatapproximately 30,000 ventriculostomies are performed annually in the United States.Ventriculoperitoneal (VP) shunt malfunction rate within the first year of initialimplantation has been reported to be as high as 11-25%. In patients with abdominaladhesions, infections or multiple failed VP shunts, another bodily compartment shouldbe utilized as a substitute for the peritoneal cavity for distal shunt catheter placement.Ventriculopleural (VPL) shunting for hydrocephalus was first introduced by Heile in1914. Since the inception of this idea, VPL shunts have been utilized in select patientswith varying degrees of success. There have been a number of case reports andseries documenting unique complications with VPL shunting, with pleural effusion andpneumothorax being the most common complications. In our review article, we soughtto review the development of VPL shunting, pleuropulmonary physiology, insertiontechniques for VPL shunt, complications associated with VPL shunts, and uniquestrategies to improve VPL shunt tolerance.
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Affiliation(s)
- Timothy Wong
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America
| | - Justin Gold
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America.
| | - Ryan Houser
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America
| | - Yehuda Herschman
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America
| | - Raja Jani
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America
| | - Ira Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark NJ, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101-1709, United States of America
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14
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Alam TM, Shaukat K, Hameed IA, Khan WA, Sarwar MU, Iqbal F, Luo S. A novel framework for prognostic factors identification of malignant mesothelioma through association rule mining. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102726] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Fan T, Zhang Y, Lv Y, Chang J, Bauer BA, Yang J, Wang CW. Cutaneous myiasis with eosinophilic pleural effusion: A case report. World J Clin Cases 2021; 9:4803-4809. [PMID: 34222451 PMCID: PMC8223839 DOI: 10.12998/wjcc.v9.i18.4803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cutaneous myiasis is frequently observed; however, eosinophilic pleural effusion induced by this condition is rare.
CASE SUMMARY We report the case of a 65-year-old female Tibetan patient from Qinghai Province, who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough, occasional hemoptysis, and right chest pain. There was no past medical and surgical history of note, except for occasional dietary habit of eating raw meat. Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung, with moist rales heard in both lungs. Chest X-rays demonstrated a left hydropneumothorax and a right lung infection. Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung. Laboratory data revealed peripheral blood eosinophilia of 37.2%, with a white blood cell count of 10.4 × 109/L. Serum immunoglobulin E levels were elevated (1650 unit/mL). Serum parasite antibodies were negative except for cysticercosis immunoglobulin G. Bone marrow aspirates were hypercellular, with a marked increase in the number of mature eosinophils and eosinophilic myelocytes. An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid. Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole (400 mg/d) for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization. Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later. After the removal of the live organisms, they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites. The patient’s symptoms were relieved soon afterwards. Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.
CONCLUSION Eosinophilic pleural fluid can be present in a wide array of disorders. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.
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Affiliation(s)
- Tao Fan
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu Zhang
- Department of Respiratory and Critical Care Medicine, Chengdu Integrated Traditional Chinese and Western Medicine Hospital, Chengdu 610016, Sichuan Province, China
| | - Yan Lv
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Chang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Brent A Bauer
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Juan Yang
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Cheng-Wei Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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16
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Chae G, Jun JB, Jung HS, Park CY, Kim JH, Kang BJ, Kang HH, Ra SW, Seo KW, Jegal Y, Ahn JJ, Park SH, Lee T. Histiocytic pleural effusion: the strong clue to malignancy. World J Surg Oncol 2021; 19:180. [PMID: 34134706 PMCID: PMC8210362 DOI: 10.1186/s12957-021-02296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. METHODS In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of ≥ 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. RESULTS Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. CONCLUSIONS The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.
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Affiliation(s)
- Ganghee Chae
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Bum Jun
- Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hwa Sik Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chui Yong Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Byung Ju Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Hyeon Hui Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Seung Won Ra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Kwang Won Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Jong Joon Ahn
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea.
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Matuchova I, Kelbich P, Kubalik J, Hanuljakova E, Stanek I, Maly V, Karpjuk O, Krejsek J. Cytological-energy analysis of pleural effusions with predominance of neutrophils. Ther Adv Respir Dis 2021; 14:1753466620935772. [PMID: 32600177 PMCID: PMC7328477 DOI: 10.1177/1753466620935772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The predominance of neutrophils in pleural effusions of patients with
different serious impairments of the pleural cavity organs is often found.
The aim of this study was to identify the type of injury using the
cytological-energy analysis of pleural effusions. Methods: We analysed 635 samples of pleural effusions with predominance of
neutrophils. We compared the values of the coefficient of energy balance
(KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST)
catalytic activities in the following subgroups of patients: with
transudative effusions, purulent pneumonia, chest empyema and after chest
surgery with and without purulent complications. Statistical analysis was
performed using the ANOVA Kruskal–Wallis test (p < 0.05
was considered as significant). Results: We found the lowest KEB values in pleural effusions of patients with chest
empyema and their gradual increases in patients with purulent pneumonia and
with transudative effusions. We observed the highest LDH and AST enzymes
activity in patients with chest empyema and their gradual decrease in
patients with purulent pneumonia and with transudative effusions. LDH and
AST enzymes activity was significantly higher in pleural effusions of
patients after chest surgery with purulent complications compared with
non-purulent cases. Conclusion: The most intensive inflammation and the most extensive tissue destruction in
the pleural cavity were found in patients with chest empyema. Significantly
better parameters were observed in patients with purulent pneumonia. The
absence of serious inflammation and the absence of tissue destruction were
typical for patients with transudative effusions. Finally, our results
confirmed an anticipated higher tissue destruction in patients after chest
surgery. Significantly worse injury was found in surgical patients with
purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Inka Matuchova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Petr Kelbich
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Socialni pece 3316/12A, 401 13, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Jan Kubalik
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Eva Hanuljakova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Ivan Stanek
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Vilem Maly
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Ondrej Karpjuk
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Jan Krejsek
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic
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18
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Liu Y, Mei B, Chen D, Cai L. GC-MS metabolomics identifies novel biomarkers to distinguish tuberculosis pleural effusion from malignant pleural effusion. J Clin Lab Anal 2021; 35:e23706. [PMID: 33528039 PMCID: PMC8059743 DOI: 10.1002/jcla.23706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background Tuberculous pleural effusions (TBPEs) and malignant pleural effusions (MPEs) are two of the most common and severe forms of exudative effusions. Clinical differentiation is challenging; however, metabolomics is a collection of powerful tools currently being used to screen for disease‐specific biomarkers. Methods 17 TBPE and 17 MPE patients were enrolled according to the inclusion criteria. The normalization gas chromatography‐mass spectrometry (GC‐MS) data were imported into the SIMCA‐P + 14.1 software for multivariate analysis. The principal component analysis (PCA) and orthogonal partial least‐squares discriminant analysis (OPLS‐DA) were used to analyze the data, and the top 50 metabolites of variable importance projection (VIP) were obtained. Metabolites were qualitatively analyzed using the National Institute of Standards and Technology (NIST) databases. Pathway analysis was performed by MetaboAnalyst 4.0. The detection of biochemical indexes such as urea and free fatty acids in these pleural effusions was also verified, and significant differences were found between these two groups. Results 1319 metabolites were screened by non‐targeted metabonomics of GC‐MS. 9 small molecules (urea, L‐5‐oxoproline, L‐valine, DL‐ornithine, glycine, L‐cystine, citric acid, stearic acid, and oleamide) were found to be significantly different (p < 0.05 for all). In OPLS‐DA, 9 variables were considered significant for biological interpretation (VIP≥1). However, after the ROC curve was performed, it was found that the metabolites with better diagnostic value were stearic acid, L‐cystine, citric acid, free fatty acid, and creatinine (AUC > 0.8), with good sensitivity and specificity. Conclusion Stearic acid, L‐cystine, and citric acid may be potential biomarkers, which can be used to distinguish between the TBPE and the MPE.
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Affiliation(s)
- Yongxia Liu
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Mei
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Deying Chen
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Long Cai
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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Pleural cytokines MIF and MIP-3α as novel biomarkers for complicated parapneumonic effusions and empyema. Sci Rep 2021; 11:1763. [PMID: 33469074 PMCID: PMC7815762 DOI: 10.1038/s41598-021-81053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022] Open
Abstract
Patients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Six cytokines were subsequently validated by enzyme-linked immunosorbent assays (ELISAs). We then used ELISA to further evaluate the diagnostic values and cutoff values of these cytokines as potential biomarkers in an expanded group that included 200 patients with uncomplicated parapneumonic effusion (UPPE), CPPE, empyema, transudates, other exudates, and malignant pleural effusion (MPE). The pleural levels of four cytokines (MIF, MIP-3α, IL-1β, ENA-78) were highest and significantly increased in CPPE/empyema compared with those in other etiologies. According to receiver operating characteristic curve analysis, the four cytokines (MIF, MIP-3α, IL-1β, and ENA-78) had areas under the curve (AUCs) greater than 0.710 for discriminating parapneumonic pleural effusion from noninfectious pleural effusions. In a comparison of nonpurulent CPPE with UPPE, logistic regression analysis revealed that pleural fluid MIF ≥ 12 ng/ml and MIP-3α ≥ 4.3 ng/ml had the best diagnostic value; MIF also displayed the highest odds ratio of 663 for nonpurulent CPPE, with 97.5% specificity, 94.44% sensitivity, and an AUC of 0.950. In conclusion, our results show that elevated MIF and MIP-3α may be used as novel biomarkers for PPE diagnosis, particularly in patients with CPPE/empyema; the findings indicate that dysregulated cytokine expression may provide clues about the pathogenesis of pleural infection.
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20
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Henríquez-Camacho C, Miralles-Aguiar F, Bernabeu-Wittel M. Emerging applications of clinical ultrasonography. Rev Clin Esp 2021; 221:45-54. [PMID: 32654759 DOI: 10.1016/j.rce.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).
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Affiliation(s)
- C Henríquez-Camacho
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Madrid, Españan
| | - F Miralles-Aguiar
- Unidad Clínica de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cádiz, España
| | - M Bernabeu-Wittel
- Unidad Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
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21
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Henríquez-Camacho C, Miralles-Aguiar F, Bernabeu-Wittel M. Emerging applications of clinical ultrasonography. Rev Clin Esp 2020; 221:45-54. [PMID: 33998478 DOI: 10.1016/j.rceng.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 10/22/2022]
Abstract
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).
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Affiliation(s)
- C Henríquez-Camacho
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - F Miralles-Aguiar
- Unidad Clínica de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M Bernabeu-Wittel
- Unidad Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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22
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Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics. Respir Med Case Rep 2020; 31:101274. [PMID: 33209575 PMCID: PMC7658704 DOI: 10.1016/j.rmcr.2020.101274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.
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23
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Borsi H, Farahnak MR, Raji H, Shooshtari MH, Pirhayati B. Comparing the diagnostic accuracy of semi-rigid and rigid pleuroscopy in diagnosis of exudative lymphocyte dominant pleural effusion with. J Family Med Prim Care 2020; 9:5256-5260. [PMID: 33409198 PMCID: PMC7773097 DOI: 10.4103/jfmpc.jfmpc_703_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pleuroscopy is an appropriate technique for visualization and biopsy of the pleural lesions, performed by two different techniques. In this study, we aimed to investigate the diagnostic accuracy of semi-rigid and rigid pleuroscopy in patients with lymphocyte dominant exudative pleural effusion. MATERIALS AND METHODS In this study, patients with lymphocyte dominant pleural effusion with negative results for tuberculosis who referred to Imam Khomeini Hospital, Ahvaz, Iran; from 2018 to 2019 were selected by census method and randomized to undergo semi-rigid or rigid pleuroscopy (30 in each group). Patients' demographic, such as age and gender, were recorded and the pathologic results reported by the two pleuroscopy methods were compared and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported for each method. All statistical analyses were performed using SPSS v. 21. RESULTS Thirty patients were included in each group. The frequency of tuberculosis, malignancy, and other causes of pleural effusion had no difference between the two methods (P > 0.05). Semirigid pleuroscopy had a sensitivity of 81.5%, specificity of 66.6%, PPV of 75.6%, and NPV of 74%, while the relevant values in rigid pleuroscopy were 87.2%, 68.4%, 87.2%, and 68.4%, respectively. CONCLUSION These results, consistent with previous studies, indicated that both semi-rigid and semi-flexible pleuroscopy methods are accurate for diagnosis of lymphocyte dominant pleural effusion when performed by skilled specialists and other considerations, such as availability and costs, can be used for selection of each method.
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Affiliation(s)
- Hamid Borsi
- Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Farahnak
- Department of Thoracic Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hanieh Raji
- Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Haddadzadeh Shooshtari
- Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnam Pirhayati
- Department of Pulmonology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Latif MZ, Shaukat K, Luo S, Hameed IA, Iqbal F, Alam TM. Risk Factors Identification of Malignant Mesothelioma: A Data Mining Based Approach. 2020 INTERNATIONAL CONFERENCE ON ELECTRICAL, COMMUNICATION, AND COMPUTER ENGINEERING (ICECCE) 2020. [DOI: 10.1109/icecce49384.2020.9179443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Dos Santos EDC, da Silva JDS, de Assis Filho MTT, Vidal MB, Monte MDC, Lunardi AC. Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial. J Physiother 2020; 66:19-26. [PMID: 31843426 DOI: 10.1016/j.jphys.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
QUESTIONS In patients with a collection of fluid in the pleural space, do mobilisation and respiratory techniques: shorten the drainage period and length of hospital stay; improve respiratory function and oxygenation; and prevent pulmonary complications? Does the addition of positive airway pressure to this regimen further improve the effects? DESIGN Randomised controlled trial with three intervention arms, concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS One hundred and fifty-six inpatients with a fluid collection in the pleural space and with chest drainage in situ. INTERVENTION Participants received usual care and were randomly assigned to: a control group that also received sham positive airway pressure (4 cmH2O) only (Con); an experimental group that received incentive spirometry, airway clearance, mobilisation and the same sham positive pressure (Exp1); or an experimental group that received the Exp1 regimen except that the positive airway pressure was 15 cmH2O (Exp2). Treatments were provided three times per day for 7 days. OUTCOME MEASURES Days of chest tube drainage, length of hospital stay, pulmonary complications and adverse events were recorded until hospital discharge. Costs in each group were estimated. RESULTS The Exp2 group had shorter duration of chest tube drainage and length of hospital stay compared with the Exp1 and Con groups. In addition, the Exp2 group had less antibiotic use (18% versus 43% versus 55%) and pneumonia incidence (0% versus 16% versus 20%) compared with the Exp1 and Con groups (all p < 0.01). The groups had similar rates of adverse events (10% versus 2% versus 6%, p > 0.05). Total treatment costs were lower in the Exp2 group than in the Exp1 and Con groups. CONCLUSIONS In patients with a fluid collection in the pleural space, the addition of positive pressure to mobilisation and respiratory techniques decreased the duration of thoracic drainage, length of hospital stay, pulmonary complications, antibiotic use and treatment costs. REGISTRATION ClinicalTrials.govNCT02246946.
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Affiliation(s)
- Elinaldo da Conceição Dos Santos
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | | | - Marcela Brito Vidal
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | - Adriana Cláudia Lunardi
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Physical Therapy, School of Medicine, Universidade de São Paulo, São Paulo, Brazil.
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Qaqish TR, Cox S, Carr R, Katlic M. Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2019; 30:25-32. [PMID: 31761281 DOI: 10.1016/j.thorsurg.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. Nonintubated thoracic surgery has more recently been applied in the management of both benign and malignant pleural effusions. This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.
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Affiliation(s)
- Thamer Robert Qaqish
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Solange Cox
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Rebecca Carr
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Mark Katlic
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA.
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Valerio E, Nunes W, Cardoso J, Santos A, Bovolim G, Domingos T, De Brot L, Saieg M. A 2-year retrospective study on pleural effusions: A cancer centre experience. Cytopathology 2019; 30:607-613. [PMID: 31306514 DOI: 10.1111/cyt.12755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cytopathological examination of pleural effusions is a fast and minimally invasive method for verification of the presence of neoplastic cells. We report our 2-year experience using a categorised diagnostic system and reporting risks of malignancy (ROMs) for each defined category. METHODS Cytological reports of patients between November 2016 and October 2018 were collected, with results primarily classified into a five-tiered classification scheme. Immunohistochemistry markers used in cytology and their results were also recorded. Final agreement to histology and overall test performance was calculated for cases with available concomitant (up to 3 months) pleural biopsies. RESULTS A total of 519 samples from 385 patients were collected, being 29 (5.6%) classified as non-diagnostic, 291 (56%) as negative, 28 (5.4%) as atypical, 30 (5.8%) as suspicious and 141 (27.2%) as positive. Most requested markers were calretinin, TTF1, Ber-EP4 and Gata-3, being conclusive in 45 (76.3%) cases. Total cyto-histological agreement was achieved in 49 (80.3%) specimens, with an overall sensitivity and specificity of 69.4% and 93.3%, respectively. Positive predictive value was 96.2% and negative predictive value was of 56%. ROM for each diagnostic category was 50% for non-diagnostic, 44% for negative, 50% for atypical, 83.3% for suspicious and 96.2% for positive. CONCLUSIONS Our 2-year retrospective study has shown a high specificity and positive predictive value for pleural cytology. The use of a five-tiered system has also shown to be highly effective, with a concordantly progressive higher ROM for the assigned diagnostic categories.
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Affiliation(s)
- Ediel Valerio
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Warley Nunes
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Jaqueline Cardoso
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Aline Santos
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Graziele Bovolim
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Tabata Domingos
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Louise De Brot
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Mauro Saieg
- Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil.,Department of Pathology, Santa Casa Medical School, São Paulo, Brazil
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28
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Wu KA, Wu CC, Liu YC, Hsueh PC, Chin CY, Wang CL, Chu CM, Shih LJ, Yang CY. Combined serum biomarkers in the noninvasive diagnosis of complicated parapneumonic effusions and empyema. BMC Pulm Med 2019; 19:108. [PMID: 31215423 PMCID: PMC6582530 DOI: 10.1186/s12890-019-0877-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/12/2019] [Indexed: 01/30/2023] Open
Abstract
Background We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema. Methods A total of 137 participates were enrolled in this study. The levels of NGAL, calprotectin, BPI and AZU-1 were measured in serum and pleural fluid by enzyme-linked immunosorbent assay. We also characterized the diagnostic values of these markers between different groups. Results The serum levels of NGAL, calprotectin, and BPI in PPE patients were significantly higher than those in transudates, noninfectious exudates, and healthy controls. The area under the curve (AUC) values of NGAL, calprotectin, and BPI for distinguishing PPE from transudates or noninfectious exudates were around 0.861 to 0.953. In PPE group, serum NGAL and calprotectin levels were significantly elevated in patients with CPPE and empyema than in those with UPPE, whereas the serum BPI levels were similar between these two groups. In CPPE and empyema patients, the serum NGAL showed a positive correlation with the pleural fluid NGAL (r = 0.417, p < 0.01). When combined with serum CRP, the sensitivity and specificity of serum calprotectin for identifying CPPE and empyema were the highest at 73.52% and 80.55%, respectively. Conclusions We concluded that serum calprotectin and NGAL were adjuvant serological markers for CPPE and empyema diagnosis. Patients present with pneumonia and pleural effusion signs in the chest x-ray and the combination of serum calprotectin and CRP constitutes a more highly sensitive and specific assay for identifying CPPE and empyema. Electronic supplementary material The online version of this article (10.1186/s12890-019-0877-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kuo-An Wu
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Ching Wu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Liu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Hsueh
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yin Chin
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Liang Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pulmonary Oncology and Interventional Bronchoscopy, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chi-Ming Chu
- Division of Biomedical Statistics and Informatics, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Li-Jane Shih
- Department of Medical Laboratory, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chia-Yu Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan. .,Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan. .,Department of Microbiology and Immunology, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 33302, Taiwan. .,Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Kelbich P, Malý V, Matuchová I, Čegan M, Staněk I, Král J, Karpjuk O, Moudrá-Wünschová I, Kubalík J, Hanuljaková E, Krejsek J. Cytological-energy analysis of pleural effusions. Ann Clin Biochem 2019; 56:630-637. [PMID: 31037951 DOI: 10.1177/0004563219845415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Simultaneous cytological and metabolic investigation of the pleural effusion provides clinically relevant information about the type and intensity of immune response in the pleural cavity. Methods We investigated 1329 pleural effusions from patients with different pathological changes in the pleural cavity. Evaluated parameters were differential cell count of neutrophils, eosinophils, lymphocytes and monocytes, and values of the coefficient of energy balance. Results We found the lowest numbers of cells and the highest coefficient of energy balance values in patients with heart failure and sepsis; relatively high frequency of eosinophils and slightly decreased coefficient of energy balance values in patients with pneumothorax and haemothorax; the predominance of lymphocytes and low coefficient of energy balance values in patients with tuberculous pleuritis; the predominance of neutrophils and variable coefficient of energy balance values in patients after chest surgery; the highest presence of neutrophils and very low coefficient of energy balance values in patients with chest empyema and the predominance of lymphocytes and normal to low coefficient of energy balance values in patients with pleural malignancy. Conclusions Our findings in patients with heart failure and sepsis suggest the absence of inflammation in the pleural cavity. We observed the manifestation of tissue repair in patients with pneumothorax and haemothorax. Patients with tuberculous pleuritis were predominantly characterized by T cell-driven immune response and oxidative burst of macrophages. We found different intensities of immune responses to the chest surgery. The typical finding in patients with empyema was oxidative burst of neutrophils. In patients with pleural malignancy, weak cytotoxic inflammation predominates together with the intensive inflammation characterized by oxidative burst of macrophages.
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Affiliation(s)
- Petr Kelbich
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic.,Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Vilém Malý
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Inka Matuchová
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic.,Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Martin Čegan
- Department of Pathology, Masaryk Hospital Ústí nad Labem, Ústí Labem nad, Czech Republic
| | - Ivan Staněk
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Jiří Král
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Ondřej Karpjuk
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Irena Moudrá-Wünschová
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Jan Kubalík
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Eva Hanuljaková
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Jan Krejsek
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
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Black pleural effusion: etiology, diagnosis, and treatment. Indian J Thorac Cardiovasc Surg 2018; 35:485-492. [PMID: 33061034 DOI: 10.1007/s12055-018-0756-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/14/2018] [Accepted: 10/03/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction Black pleural effusion (BPE) is an extremely rare entity. This review aims to increase the attention of thoracic physicians and surgeons to the differential diagnosis and management of unfamiliar cases with BPE. Methods Searching MEDLINE, Pubmed, and Web of Science databases with the words of "black pleural effusion" in title/abstract yielded 86 articles relevant to the topic of the review. There were only 20 case reports describing BPE with different underlying causes. Results BPE may occur as a result of fungal Aspergillus niger or Rhizopus oryzae infection, metastatic melanoma, pancreaticopleural fistula (PPF), hemolysis after massive intrapleural bleeding, or other miscellaneous causes. A stepwise approach should be followed for diagnosis of BPE including chest x-ray, diagnostic thoracocentesis, cytology and culture of the pleural fluid, thoracic or thoraco-abdominal computed tomography (CT), and tissue biopsy for pathological examination. Pleural fluid drainage is a sufficient treatment of BPE in most of the cases, and pleurodesis can be performed as part of palliative care. The definite treatment of the underlying causes of BPE, namely, pulmonary aspergillosis, metastatic melanoma, pulmonary adenocarcinoma, or PPF, is mandatory to achieve favorable outcome. Conclusions BPE is not a common clinical condition which may hide a critical disease including invasive pulmonary aspergillosis, metastatic melanoma, lung cancer, and PPF, thus awareness of this rare entity is crucial to prevent subsequent complications and to avoid delayed diagnosis of the underlying cause.
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Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study. Int J Infect Dis 2018; 78:34-38. [PMID: 30449728 DOI: 10.1016/j.ijid.2018.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/06/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The confirmatory diagnosis of pleural tuberculosis (pTB) remains challenging. The aim of this study was to describe the clinical and epidemiological characteristics of pTB patients and assess the yield of different diagnostic procedures in a low burden country with a high rate of immigrant population. METHODS All adult patients with pTB between 2007 and 2014 were studied retrospectively. RESULTS One hundred and three out of 843 patients with tuberculosis had pTB. Fifty-three (54.1%) were male, and the median age was 45years (range 18-87years). Fifty-two (50.49%) patients were immigrants. A confirmed diagnosis was reached in 16 patients (15.5%) by microbiological studies of pleural effusion. Lung involvement was demonstrated by sputum smear microscopy in 13/49 (26.5%), sputum GeneXpert MTB/RIF test in 13/20 (65%), and sputum culture in 16/37 (43.2%). High-resolution computed tomography (CT) showed lung involvement in 47.7% of the patients. The cure rate was 91.3% at the 1-year follow-up. Three patients died, all of them within the first month after diagnosis. CONCLUSIONS The detection of lung involvement increased by two-fold when lung CT was used; this correlated with the likelihood of finding a positive microbiological result on sputum sample testing. Pleural microbiological studies had a low diagnostic yield, and sputum could have a complementary role.
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Zirlik S, Hildner K, Rieker RJ, Vieth M, Neurath MF, Fuchs FS. Confocal Laser Endomicroscopy for Diagnosing Malignant Pleural Effusions. Med Sci Monit 2018; 24:5437-5447. [PMID: 30078032 PMCID: PMC6091162 DOI: 10.12659/msm.909989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Confocal laser endomicroscopy (CLE) enables “in vivo” microscopic tissue diagnosis based on tissue reflectance or tissue fluorescence upon application of fluorescence agents. The aim of the present study was to evaluate CLE as a new diagnostic approach for differentiation between malignant versus non-malignant pleural effusions. Material/Methods In 100 patients with pleural effusions, thoracentesis was performed. Cresyl violet and acriflavine were used as contrast agents for probe-based CLE of effusions. CLE video sequences were assessed by 4 independent investigators (2 experienced in this technique, 2 with only basic knowledge). In addition, all CLE samples were evaluated by an expert pathologist (p). Results were compared with conventional cytology of effusions and histology of cell blocks. Results CLE reliably permitted identification of malignant cells in pleural effusions. Sensitivity for detection of malignant effusions was 87% (p: 87%) and 81% (p: 72%) for acriflavine and cresyl violet, respectively. With regard to specificity, acriflavine and cresyl violet yielded a mean value of 99% (p: 100%) and 92% (p: 100%). Conclusions In this pilot study, CLE permitted simple and rapid detection of malignant pleural effusions. Larger prospective studies are warranted to corroborate our findings.
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Affiliation(s)
- Sabine Zirlik
- Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kai Hildner
- Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Joachim Rieker
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Vieth
- Department of Pathology, Clinical Center of Bayreuth, Bayreuth, Germany
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Ibitoye BO, Idowu BM, Ogunrombi AB, Afolabi BI. Ultrasonographic quantification of pleural effusion: comparison of four formulae. Ultrasonography 2018; 37:254-260. [PMID: 29228764 PMCID: PMC6044225 DOI: 10.14366/usg.17050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the correlations of ultrasonographically estimated volumes of pleural fluid with the actual effusion volume in order to determine the most reliable formula. METHODS In 32 consecutive patients with clinically diagnosed pleural effusion, an ultrasound estimation was made of the volume of effusion using four different formulae, including two in the erect position and two in the supine position. Closed-tube thoracostomy drainage using a 28-Fr chest tube was performed. The total drainage was calculated after confirmation of full lung re-expansion and complete drainage by plain chest radiographs and ultrasound. The ultrasonographically estimated volume was compared to the actual total volume drained as the gold standard. RESULTS There were 14 female and 18 male subjects. The mean age of all subjects was 41.56±18.34 years. Fifty percent of the effusions were in the left hemithorax. Metastatic disease accounted for the plurality of effusions (31.2%). The mean total volume drained for all the subjects was 2,770±1,841 mL. The ultrasonographically estimated volumes for the erect 1, erect 2, supine 1, and supine 2 formulae were 1,816±753 mL, 1,520±690 mL, 2,491±1,855 mL, and 1,393±787 mL, respectively. The Pearson correlation coefficients (r) for the estimate of each formula were 0.75, 0.81, 0.62, and 0.63, respectively. CONCLUSION Although both erect formulae showed similar correlations, the erect 2 formula (Goecke 2) was most closely correlated with the actual volume drained.
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Affiliation(s)
- Bolanle Olubunmi Ibitoye
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Bukunmi Michael Idowu
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Babalola Ishmael Afolabi
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Neoh KH, Hassan AA, Chen A, Sun Y, Liu P, Xu KF, Wong AS, Han RP. Rethinking liquid biopsy: Microfluidic assays for mobile tumor cells in human body fluids. Biomaterials 2018; 150:112-124. [DOI: 10.1016/j.biomaterials.2017.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
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Uemura A, Fukayama T, Tanaka T, Hasegawa-Baba Y, Shibutani M, Tanaka R. Development of an Anti-Adhesive Membrane for Use in Video-Assisted Thoracic Surgery. Int J Med Sci 2018; 15:689-695. [PMID: 29910673 PMCID: PMC6001413 DOI: 10.7150/ijms.24050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 01/21/2023] Open
Abstract
Background: The need to prevent postoperative adhesions after surgery has been considered a significant challenge in thoracic surgery, especially with the advent of video-assisted thoracic surgery (VATS). While preventive materials for postoperative adhesions have been studied for many years, they are all still in the development phases. Methods: In this animal study, an insoluble hyaluronic acid membrane was used in VATS for wedge resection to test its operability and to examine the body's response to the membrane. Ten beagles were divided into two groups, an experimental group and a negative control group. In the experimental group, an insoluble hyaluronic acid membrane containing glycerol was used as the test membrane (10 x 10 x 0.1 cm3). The test membrane was implanted in the left thoracic cavity of the animal under VATS following wedge resection. The animals were observed for two weeks and then euthanized for examination. Results: Macroscopically, the median adhesion score was lower in the experimental group (0) than in the control group (2.5). On histopathological examination, the test membrane elicited only a minor inflammatory response and foreign body reaction. Conclusion: The test membrane showed satisfactory operability and appears to be a practical material to prevent postoperative adhesions after thoracic surgery in VATS.
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Affiliation(s)
- Akiko Uemura
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Toshiharu Fukayama
- National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Takashi Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Yasuko Hasegawa-Baba
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Makoto Shibutani
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Ryou Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
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Abstract
Malignant pleural effusion is a common complication of cancer and denotes a poor prognosis. It usually presents with dyspnea and a unilateral large pleural effusion. Thoracic computed tomography scans and ultrasound are helpful in distinguishing malignant from benign effusions. Pleural fluid cytology is diagnostic in about 60% of cases. In cytology-negative disease, pleural biopsies are helpful. Current management is palliative. Previously, first-line treatment for recurrent symptomatic malignant pleural effusion was chest drain insertion and talc pleurodesis, with indwelling pleural catheter insertion reserved for patients with trapped lung or failed talc pleurodesis. However, catheter insertion is an increasingly acceptable first-line treatment.
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Affiliation(s)
- Rachelle Asciak
- Respiratory Medicine, Oxford University Hospitals, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, Great Britain
| | - Najib M Rahman
- Respiratory Medicine, Oxford University Hospitals, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, Great Britain.
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Wang Y, Xu YM, Zou YQ, Lin J, Huang B, Liu J, Li J, Zhang J, Yang WM, Min QH, Li SQ, Gao QF, Sun F, Chen QG, Zhang L, Jiang YH, Deng LB, Wang XZ. Identification of differential expressed PE exosomal miRNA in lung adenocarcinoma, tuberculosis, and other benign lesions. Medicine (Baltimore) 2017; 96:e8361. [PMID: 29095265 PMCID: PMC5682784 DOI: 10.1097/md.0000000000008361] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Pleural effusion (PE) is a common clinical complication of many pulmonary and systemic diseases, including lung cancer and tuberculosis. Nevertheless, there is no clinical effective biomarker to identify the cause of PE. We attempted to investigate differential expressed exosomal miRNAs in PEs of lung adenocarcinoma (APE), tuberculous (TPE), and other benign lesions (NPE) by using deep sequencing and quantitative polymerase chain reaction (qRT-PCR). As a result, 171 differentiated miRNAs were observed in 3 groups of PEs, and 11 significantly differentiated exosomal miRNAs were validated by qRT-PCR. We identified 9 miRNAs, including miR-205-5p, miR-483-5p, miR-375, miR-200c-3p, miR-429, miR-200b-3p, miR-200a-3p, miR-203a-3p, and miR-141-3p which were preferentially represented in exosomes derived from APE when compared with TPE or NPE, while 3 miRNAs, including miR-148a-3p, miR-451a, and miR-150-5p, were differentially expressed between TPE and NPE. These different miRNAs profiles may hold promise as biomarkers for differential diagnosis of PEs with more validation based on larger cohorts.
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Affiliation(s)
- Yan Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
- Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guizhou
| | - Yan-Mei Xu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Ye-Qing Zou
- The Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Jin Lin
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Bo Huang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Jing Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Jing Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University
| | - Jing Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Wei-Ming Yang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Qing-Hua Min
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Shu-Qi Li
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Qiu-Fang Gao
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Fan Sun
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Qing-Gen Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Lei Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Yu-Huan Jiang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
| | - Li-Bin Deng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
- Institute of Translational Medicine, Nanchang University, Jiangxi, China
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Jiangxi
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The role of thoracoscopy in management and outcome of stage II thoracic parapneumonic empyema: review of 148 cases. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sobhey K, Naglaa B. Diagnostic significance of pleural fluid pH and pCO2. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Becker BA, Fields WA, Pfisterer L, Stuntz RM, Stahlman BA, Kochert EI. Extrabiliary Pathology Identified by Right Upper Quadrant Abdominal Ultrasound in Emergency Department Patients. J Emerg Med 2015; 50:92-8. [PMID: 26409669 DOI: 10.1016/j.jemermed.2015.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/22/2015] [Accepted: 07/25/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effectiveness of point of care (POC) right upper quadrant ultrasound (RUQ US) in the diagnosis of biliary disease has been well studied. Extrabiliary pathology that might remain undetected in the course of typical, focused POC RUQ US has not been directly examined. OBJECTIVES Our objective was to determine the prevalence and clinical significance of extrabiliary findings (EBFs) seen on radiology-performed, comprehensive RUQ US. METHODS We conducted a retrospective review of all adult patients undergoing radiology-performed RUQ US in the emergency department (ED) between January 2007 and April 2012. Ultrasound findings and contemporaneous laboratory values were collected. EBFs were identified and further classified by clinical significance. RESULTS A total of 1579 charts were included, demonstrating a total of 1030 EBFs, with 747 (47.3% [95% confidence interval {CI}, 44.8-49.8%]) patients demonstrating ≥ 1 EBF. Of these EBFs, 184 were classified as clinically significant (CSEBFs) and 150 (9.5% [95% CI, 8.1-11.0%]) patients had ≥ 1 CSEBF. A total of 50 unspecified masses were seen in 47 (3.0% [95% CI, 2.1-3.8%]) patients, with 8 (0.5%) representing a previously undiagnosed malignancy. CONCLUSION CSEBFs were seen in < 10% of ED patients undergoing comprehensive RUQ US. Nonspecific masses were seen in 3% of patients, but < 1% of patients were found to have a new malignancy.
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Affiliation(s)
- Brent A Becker
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - William A Fields
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - Lauren Pfisterer
- Department of Emergency Medicine, Memorial Hospital, York, Pennsylvania
| | - Robert M Stuntz
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - Barbara A Stahlman
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - Erik I Kochert
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
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41
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The impact of pleural disease on the management of advanced ovarian cancer. Gynecol Oncol 2015; 138:216-20. [PMID: 25969350 DOI: 10.1016/j.ygyno.2015.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/04/2015] [Indexed: 11/20/2022]
Abstract
Malignant pleural effusion is the most common site of stage IV ovarian cancer. A positive cytology is required for a stage IVA diagnosis. Unfortunately, the accuracy rate of pleural cytology remains low. A number of factors have been identified as prognostic for clinical outcomes in patients with epithelial ovarian cancer (EOC), the International Federation of Gynaecology and Obstetrics (FIGO) stage and residual tumor after debulking surgery being the most widely reported. Thereby careful selection of patients is crucially important, yet no preoperative predictor has proven sufficiently reliable to predict surgical outcome. The authors present a review of the literature on stage IV ovarian cancer specifically focusing on prognostic value of FIGO stage, preoperative workup, role of video-assisted thoracic surgery and maximal cytoreductive surgery.
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42
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Henriquez-Camacho C, Garcia-Casasola G, Guillén-Astete C, Losa J. Ultrasound for the diagnosis of infectious diseases: Approach to the patient at point of care and at secondary level. J Infect 2015; 71:1-8. [PMID: 25797569 DOI: 10.1016/j.jinf.2015.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/25/2015] [Accepted: 03/13/2015] [Indexed: 12/27/2022]
Abstract
Bedside ultrasound evaluation for infection can be performed promptly at the bedside, using simple equipment and without irradiation. Visualization of the foci often enables prompt antimicrobial therapy and even early ultrasound-guided procedure, facilitating earlier confirmation. These procedures are made safer using the real-time visual control that ultrasound provides. Future challenges for an infectious diseases specialist include gaining experience about the appropriate use of point-of-care ultrasound (POCUS). Ultrasonography training is required to ensure competent use of this technology.
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Affiliation(s)
| | | | | | - Juan Losa
- Infectious Diseases Department, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
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