BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Pos...BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.展开更多
BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial ...BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.展开更多
I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload du...I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.展开更多
BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique mani...BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.展开更多
BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosi...BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosine deaminase(ADA)is an inflammatory mediator detected at increased levels in the pleural fluid.AIM To determine the role of total pleural ADA(P-ADA)levels in the diagnosis of pleural inflammatory diseases.METHODS 157 patients with inflammatory pleural effusion(exudates,n=124,79%)and noninflammatory pleural effusion(transudates,n=33,21%)were included in this observational retrospective cohort study.The P-ADA assay was tested using a kinetic technique.The performance of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.RESULTS The transudates included congestive heart failure(n=26),cirrhosis of the liver with ascites(n=3),chronic renal failure(n=3),and low total protein levels(n=1).The exudate cases included tuberculosis(n=44),adenocarcinoma(n=37),simple parapneumonic effusions(n=15),complicated parapneumonic effusions/empyema(n=8),lymphoma(n=7),and other diseases(n=13).The optimal cutoff value of P-ADA was≥9.00 U/L.The diagnostic parameters as sensitivity,specificity,positive and negative predictive values,positive and negative likelihood values,odds ratio,and accuracy were 77.69(95%CI:69.22-84.75);68.75(95%CI:49.99-83.88);90.38 and 44.90(95%CI:83.03-95.29;30.67-59.77);2.48 and 0.32(95%CI:2.21-11.2;0.27-0.51);7.65(95%CI:0.78-18.34),and 75.82(95%CI:68.24-82.37),respectively(χ^(2)=29.51,P=0.00001).An AUC value of 0.8107(95%CI:0.7174-0.8754;P=0.0000)was clinically useful.The Hosmer-Lemeshow test showed excellent discrimination.CONCLUSION P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.展开更多
This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishi...This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishing between inflammatory and non-inflammatory causes of pleural effusion remains a diagnostic challenge.The authors conducted a rigorous retrospective cohort analysis of 157 patients(124 with inflammatory exudates and 33 with non-inflammatory transudates),establishing a robust cutoff value of P-ADA≥9.00 U/L for diagnosing inflammatory diseases using receiver operating characteristic curve analysis and internal statistical calibration.This is the first study to define a standardized PADA threshold in a Brazilian cohort,addressing previous inconsistencies in cutoff values.Furthermore,the authors delved into the pathophysiological mechanisms underlying elevated P-ADA,linking it to purinergic signaling pathways and immune cell activation,particularly emphasizing the role of ADA2 isoforms in macrophages and lymphocytes.Their findings support P-ADA as a non-invasive,cost-effective biomarker for early diagnosis,treatment stratification,and minimizing the need for invasive procedures such as thoracentesis.This has particular relevance in resource-limited settings,where streamlined diagnostics can reduce healthcare costs and improve patient outcomes.Future studies must prioritize global validation,explore the integration of adenosine deaminase with additional biomarkers(e.g.,interleukin 6,C-reactive protein),and support the development of point-of-care technologies.展开更多
Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-infla...Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-inflammatory transudates.Adenosine deaminase(ADA),an enzyme primarily produced by immune cells,particularly lymphocytes,increase in response to inflammatory conditions,including tuberculosis and malignancies.Elevated ADA levels in pleural have been shown to correlate with inflammatory exudates,making it a valuable biomarker for dif-ferentiating between inflammatory and non-inflammatory effusions.Moreover,numerous studies have demonstrated the treatment function of ADA in inflammation-related pleural effusion syndrome.Recently,research has established the values for the implication of ADA in diagnosing and managing pleural disease.Based on these findings,ADA becomes a reliable,non-invasive marker for early diagnosis and the appropriate treatment for pleural inflammation,ultimately improving patient outcomes.展开更多
BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly importan...BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly important,which can help improve patient prognosis and enhance quality of life.CASE SUMMARY A 47 year old male underwent DC for traumatic brain herniation.After surgery,he developed stubborn subdural effusion(SDE)on the contralateral side and underwent multiple subdural drilling and drainage surgeries,but only temporarily improved the patient’s symptoms.After the final cranioplasty,the contralateral SDE completely disappeared.The patient did not experience any new contralateral neurological dysfunction,and the Glasgow prognostic score was 11 points(E4V1M6).CONCLUSION For neurosurgeons,accurate assessment of the condition is necessary when treating patients with stubborn SDE after DC surgery,and timely cranioplasty can be performed to avoid multiple surgeries.This is a safe and effective surgical method for treating traumatic subdural effusion.展开更多
Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by...Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by TBC spraying is an approved design.To protect both metal and TBC synchronously,a recommended geometry of crater is obtained through a fully automatic multi-objective optimization combined with conjugate heat transfer simulation in this work.The length and width of crater(i.e.,L/D and W/D)were applied as design variables,and the area-averaged overall effectiveness of the metal and TBC surfaces(i.e.,Φ_(av) and τ_(av))were selected as objective functions.The optimization procedure consists of automated geometry and mesh generation,conjugate heat transfer simulation validated by experimental data and Kriging surrogated model.The results showed that the Φ_(av) and τ_(av) are successfully increased respectively by 9.1%and 6.0%through optimization.Appropriate enlargement of the width and length of the crater can significantly improve the film coverage effect,since that the beneficial anti-CRVP is enhanced and the harmful CRVP is weakened.展开更多
This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjuste...This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjusted based on the existing human ear finite element(FE)model,and the accuracy of the model was validated using experimental data.Secondly,six FE models were developed to simulate varying degrees of MEE by systematically altering the material properties of the middle ear cavity(MEC)at different anatomical locations.Finally,the effects of these six FE models,representing varying degrees of MEE,on sound transmission characteristics and energy absorption(EA)rate in the human ear were systematically analyzed.When the degree of MEE is less than 50%of the MEC volume,its impact on the sound transmission characteristics of the human ear remains minimal,resulting in an estimated hearing loss of approximately 3 dB,with EA rate remaining close to normal levels.Once the effusion exceeds 50%of the MEC volume,a significant deterioration in acoustic transmission is observed,accompanied by a flattening of the EA curve and a drop in EA rates to below 20%.When the effusion completely fills the MEC,the maximum hearing loss reaches 46.47 dB,and the EA rate approaches zero across the entire frequency range.These findings provide theoretical insights into the biomechanical effects of MEE on human auditory transmission and offer a reference for clinical diagnosis and evaluation.展开更多
BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy w...BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.展开更多
Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye f...Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye for unknown reasons;it accumulates in the choroid and subretinal space,leading to choroidal and ciliary body detachment and nonrhegmatogenous retinal detachment[1].The diagnosis of IUES requires the exclusion of other causes of uveal effusion,such as choroidal tumors,uveitis,and surgical causes[2-3].展开更多
Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is conside...Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is considered an optimal biomarker for diagnosing TP.This study aimed to evaluate the applicability of cf-TB testing across diverse research sites with a relatively large sample size.Methods:Patients suspected of TP and presenting with clinical symptoms and radiological evidence of PE were consecutively enrolled by treating physicians from 11 research sites across 6 provinces in China between April 2020 and August 2022.Following centrifugation,sediments obtained from PE were used for Xpert MTB/RIF(Xpert)and mycobacterial culture,while the supernatants were subjected to cf-TB testing.This study employed a composite reference standard to definite TP,which was characterized by any positive result for Mycobacterium tuberculosis(MTB)through either PE culture,PE Xpert,or pleural biopsy.Results:A total of 1412 participants underwent screening,and 1344(95.2%)were subsequently enrolled in this study.Data from 1241(92.3%)participants were included,comprising 284 with definite TP,677 with clinically diagnosed TP,and 280 without TP.The sensitivity of cf-TB testing in definite TP was 73.6%(95%CI 68.2%-78.4%),significantly higher than both Xpert(40.8%,95%CI 35.3%-46.7%,P<0.001)and mycobacterial culture(54.2%,95%CI 48.4%-59.9%,P<0.001).When clinically diagnosed TP was incorporated into the composite reference standard for sensitivity analysis,cf-TB testing showed a sensitivity of 46.8%(450/961,95%CI 43.7%-50.0%),significantly higher than both Xpert(12.1%,116/961,95%CI 10.2%-14.3%,P<0.001)and mycobacterial culture(16.0%,154/961,95%CI 13.8%-18.5%,P<0.001).The specificities of cf-TB testing,Xpert,and mycobacterial culture were all 100.0%.Conclusions:The performance of cf-TB testing is significantly superior to that of Xpert and mycobacterial culture methods,indicating that it can be considered as the primary diagnostic approach for improving TP detection.Trial registration:The trial was registered on Chictr.org.cn(ChiCTR2000031680,https://www.chictr.org.cn/showproj.html?proj=49316).展开更多
In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of m...In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.展开更多
The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amy...The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.展开更多
A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like...A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like lymphoma) with massive ascites. The patient’s clinical course was complicated by acute renal insufficiency and hypotension, which led to death within 2 wk. In general, patients with IBD may have an increased risk for development of lymphoma, which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies. PEL is a rare subset of lymphoma localized to serous body cavities, lacks tumor mass or nodal involvement, and is associated with infection by human herpes virus 8 (HHV-8). Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections. This type of lymphoma is classified as PEL-like lymphoma. Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy, but to the best of our knowledge, the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD.展开更多
This paper presents the diagnosis of effusion of the knee by ultrasound. 140patients with pain and swelling of the knee were detected to have suprapatellar effusion by ultrasound. The antero-posterior distances of the...This paper presents the diagnosis of effusion of the knee by ultrasound. 140patients with pain and swelling of the knee were detected to have suprapatellar effusion by ultrasound. The antero-posterior distances of the suprapatellar effusion were 0. 2-3. 4 cm with a mean of 1. 2 cm. The effusion was revealed as an anechoic fluid-filled area in 121 cases (86. 4 %), as a hypoechoic area in 15 cases (10. 7 %), and as a mixed anechoic fluid-filled area and hypoechoic area in remaining 4 (2. 9 %). Of 140 cases of knee effusion, 126 cases were verified by aspiration or operation. The results obtaineddemonstrate that ultrasound can visualize not only the effusion of the knee, but also theabnormalities in the menisci, synovium, and the popliteal fossa ; This provides an important basis for diagnosis and treatment. Further more, ultrasound is painfree, noninvasive, inexpensive, readily acceptable by patients,and convenient for follow-up studles.展开更多
Otitis media with effusion(OME)is a frequent paediatric disorder.The condition is often asymptomatic,and so can easily be missed.However,OME can lead to hearing loss that impairs the child's language and behaviour...Otitis media with effusion(OME)is a frequent paediatric disorder.The condition is often asymptomatic,and so can easily be missed.However,OME can lead to hearing loss that impairs the child's language and behavioural development.The diagnosis is essentially clinical,and is based on otoscopy and(in some cases)tympanometry.Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected.Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart.Hearing must be evaluated(using an age-appropriate audiometry technique)before and after treatment,so as not to miss another underlying cause of deafness(e.g.perception deafness).Craniofacial dysmorphism,respiratory allergy and gastro-oesophageal reflux all favour the development of OME.Although a certain number of medications(antibiotics,corticoids,antihistamines,mucokinetic agents,and nasal decongestants)can be used to treat OME,they are not reliably effective and rarely provide long-term relief.The benchmark treatment for OME is placement of tympanostomy tubes(TTs)and(in some cases)adjunct adenoidectomy.The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear.In contrast,TTs do not prevent progression towards tympanic atrophy or a retraction pocket.Adenoidectomy enhances the effectiveness of TTs.In children with adenoid hypertrophy,adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy.Children must be followed up until OME has disappeared completely,so that any complications are not missed.展开更多
AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patient...AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.展开更多
Objective:To evaluate the diagnostic value of endostatin(ES),vascular endothelial growth factor (VEGF) and careinoembryonie antigen(CEA) in both serum and pleural effusion of lung cancer patients.Methods:Levels of ES,...Objective:To evaluate the diagnostic value of endostatin(ES),vascular endothelial growth factor (VEGF) and careinoembryonie antigen(CEA) in both serum and pleural effusion of lung cancer patients.Methods:Levels of ES,VEGF and CEA in 52 malignant pleural effusion due to lung cancer and 50 patients with non-malignant disease were measured by using sandwich enzymelinked immunosorbent assay and microparticle enzyme immunoassay.Results:The ES.VEGF and CEA levels in pleural effusion and serum,and their ratio(F/S) were higher in lung cancer group than that in benign group,and the differences were statistically significant(P【0.05).The diagnostic efficiency of ES+VEGF for lung cancer was superior to either single detection.The diagnostic efficiency of ES+VEGK+CEA was superior to either ES+VEGF or ES+CEA.Conclusions: The results suggest that ES,VEGF and CEA might be useful in the differentiation between benign and malignant pleural effusion due to lung cancer.In comparison with either single determination of concentration in serum or pleural fluid,the couiljined detection of two or three markers is of important clinical significance in the diagnosis of lung cancer.展开更多
文摘BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.
文摘BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.
基金Supported by Shaanxi Science and Technology Project(No.2022SF-434)Xi’an Science and Technology Project(No.21YXYJ0044).
文摘I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.
文摘BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.
文摘BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosine deaminase(ADA)is an inflammatory mediator detected at increased levels in the pleural fluid.AIM To determine the role of total pleural ADA(P-ADA)levels in the diagnosis of pleural inflammatory diseases.METHODS 157 patients with inflammatory pleural effusion(exudates,n=124,79%)and noninflammatory pleural effusion(transudates,n=33,21%)were included in this observational retrospective cohort study.The P-ADA assay was tested using a kinetic technique.The performance of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.RESULTS The transudates included congestive heart failure(n=26),cirrhosis of the liver with ascites(n=3),chronic renal failure(n=3),and low total protein levels(n=1).The exudate cases included tuberculosis(n=44),adenocarcinoma(n=37),simple parapneumonic effusions(n=15),complicated parapneumonic effusions/empyema(n=8),lymphoma(n=7),and other diseases(n=13).The optimal cutoff value of P-ADA was≥9.00 U/L.The diagnostic parameters as sensitivity,specificity,positive and negative predictive values,positive and negative likelihood values,odds ratio,and accuracy were 77.69(95%CI:69.22-84.75);68.75(95%CI:49.99-83.88);90.38 and 44.90(95%CI:83.03-95.29;30.67-59.77);2.48 and 0.32(95%CI:2.21-11.2;0.27-0.51);7.65(95%CI:0.78-18.34),and 75.82(95%CI:68.24-82.37),respectively(χ^(2)=29.51,P=0.00001).An AUC value of 0.8107(95%CI:0.7174-0.8754;P=0.0000)was clinically useful.The Hosmer-Lemeshow test showed excellent discrimination.CONCLUSION P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.
文摘This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishing between inflammatory and non-inflammatory causes of pleural effusion remains a diagnostic challenge.The authors conducted a rigorous retrospective cohort analysis of 157 patients(124 with inflammatory exudates and 33 with non-inflammatory transudates),establishing a robust cutoff value of P-ADA≥9.00 U/L for diagnosing inflammatory diseases using receiver operating characteristic curve analysis and internal statistical calibration.This is the first study to define a standardized PADA threshold in a Brazilian cohort,addressing previous inconsistencies in cutoff values.Furthermore,the authors delved into the pathophysiological mechanisms underlying elevated P-ADA,linking it to purinergic signaling pathways and immune cell activation,particularly emphasizing the role of ADA2 isoforms in macrophages and lymphocytes.Their findings support P-ADA as a non-invasive,cost-effective biomarker for early diagnosis,treatment stratification,and minimizing the need for invasive procedures such as thoracentesis.This has particular relevance in resource-limited settings,where streamlined diagnostics can reduce healthcare costs and improve patient outcomes.Future studies must prioritize global validation,explore the integration of adenosine deaminase with additional biomarkers(e.g.,interleukin 6,C-reactive protein),and support the development of point-of-care technologies.
文摘Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-inflammatory transudates.Adenosine deaminase(ADA),an enzyme primarily produced by immune cells,particularly lymphocytes,increase in response to inflammatory conditions,including tuberculosis and malignancies.Elevated ADA levels in pleural have been shown to correlate with inflammatory exudates,making it a valuable biomarker for dif-ferentiating between inflammatory and non-inflammatory effusions.Moreover,numerous studies have demonstrated the treatment function of ADA in inflammation-related pleural effusion syndrome.Recently,research has established the values for the implication of ADA in diagnosing and managing pleural disease.Based on these findings,ADA becomes a reliable,non-invasive marker for early diagnosis and the appropriate treatment for pleural inflammation,ultimately improving patient outcomes.
文摘BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly important,which can help improve patient prognosis and enhance quality of life.CASE SUMMARY A 47 year old male underwent DC for traumatic brain herniation.After surgery,he developed stubborn subdural effusion(SDE)on the contralateral side and underwent multiple subdural drilling and drainage surgeries,but only temporarily improved the patient’s symptoms.After the final cranioplasty,the contralateral SDE completely disappeared.The patient did not experience any new contralateral neurological dysfunction,and the Glasgow prognostic score was 11 points(E4V1M6).CONCLUSION For neurosurgeons,accurate assessment of the condition is necessary when treating patients with stubborn SDE after DC surgery,and timely cranioplasty can be performed to avoid multiple surgeries.This is a safe and effective surgical method for treating traumatic subdural effusion.
基金Anhui Provincial Natural Science Foundation of China(2108085ME176)the Natural Science Foundation of China(52276043)。
文摘Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by TBC spraying is an approved design.To protect both metal and TBC synchronously,a recommended geometry of crater is obtained through a fully automatic multi-objective optimization combined with conjugate heat transfer simulation in this work.The length and width of crater(i.e.,L/D and W/D)were applied as design variables,and the area-averaged overall effectiveness of the metal and TBC surfaces(i.e.,Φ_(av) and τ_(av))were selected as objective functions.The optimization procedure consists of automated geometry and mesh generation,conjugate heat transfer simulation validated by experimental data and Kriging surrogated model.The results showed that the Φ_(av) and τ_(av) are successfully increased respectively by 9.1%and 6.0%through optimization.Appropriate enlargement of the width and length of the crater can significantly improve the film coverage effect,since that the beneficial anti-CRVP is enhanced and the harmful CRVP is weakened.
基金supported by the National Natural Science Foundation of China(52275296)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjusted based on the existing human ear finite element(FE)model,and the accuracy of the model was validated using experimental data.Secondly,six FE models were developed to simulate varying degrees of MEE by systematically altering the material properties of the middle ear cavity(MEC)at different anatomical locations.Finally,the effects of these six FE models,representing varying degrees of MEE,on sound transmission characteristics and energy absorption(EA)rate in the human ear were systematically analyzed.When the degree of MEE is less than 50%of the MEC volume,its impact on the sound transmission characteristics of the human ear remains minimal,resulting in an estimated hearing loss of approximately 3 dB,with EA rate remaining close to normal levels.Once the effusion exceeds 50%of the MEC volume,a significant deterioration in acoustic transmission is observed,accompanied by a flattening of the EA curve and a drop in EA rates to below 20%.When the effusion completely fills the MEC,the maximum hearing loss reaches 46.47 dB,and the EA rate approaches zero across the entire frequency range.These findings provide theoretical insights into the biomechanical effects of MEE on human auditory transmission and offer a reference for clinical diagnosis and evaluation.
文摘BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.
基金Supported by the National Natural Science Foundation of China(No.81600747)Foundation of Liaoning Province Education Administration(No.JYTMS20230089)Joint Project Planned by the Department of Science and Technology of Liaoning Province(No.2023JH2/101700129).
文摘Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye for unknown reasons;it accumulates in the choroid and subretinal space,leading to choroidal and ciliary body detachment and nonrhegmatogenous retinal detachment[1].The diagnosis of IUES requires the exclusion of other causes of uveal effusion,such as choroidal tumors,uveitis,and surgical causes[2-3].
基金supported by the Beijing Municipal Science and Technology Project(Z191100006619079)the General Program of the National Natural Science Foundation of China(82072381).
文摘Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is considered an optimal biomarker for diagnosing TP.This study aimed to evaluate the applicability of cf-TB testing across diverse research sites with a relatively large sample size.Methods:Patients suspected of TP and presenting with clinical symptoms and radiological evidence of PE were consecutively enrolled by treating physicians from 11 research sites across 6 provinces in China between April 2020 and August 2022.Following centrifugation,sediments obtained from PE were used for Xpert MTB/RIF(Xpert)and mycobacterial culture,while the supernatants were subjected to cf-TB testing.This study employed a composite reference standard to definite TP,which was characterized by any positive result for Mycobacterium tuberculosis(MTB)through either PE culture,PE Xpert,or pleural biopsy.Results:A total of 1412 participants underwent screening,and 1344(95.2%)were subsequently enrolled in this study.Data from 1241(92.3%)participants were included,comprising 284 with definite TP,677 with clinically diagnosed TP,and 280 without TP.The sensitivity of cf-TB testing in definite TP was 73.6%(95%CI 68.2%-78.4%),significantly higher than both Xpert(40.8%,95%CI 35.3%-46.7%,P<0.001)and mycobacterial culture(54.2%,95%CI 48.4%-59.9%,P<0.001).When clinically diagnosed TP was incorporated into the composite reference standard for sensitivity analysis,cf-TB testing showed a sensitivity of 46.8%(450/961,95%CI 43.7%-50.0%),significantly higher than both Xpert(12.1%,116/961,95%CI 10.2%-14.3%,P<0.001)and mycobacterial culture(16.0%,154/961,95%CI 13.8%-18.5%,P<0.001).The specificities of cf-TB testing,Xpert,and mycobacterial culture were all 100.0%.Conclusions:The performance of cf-TB testing is significantly superior to that of Xpert and mycobacterial culture methods,indicating that it can be considered as the primary diagnostic approach for improving TP detection.Trial registration:The trial was registered on Chictr.org.cn(ChiCTR2000031680,https://www.chictr.org.cn/showproj.html?proj=49316).
基金This project was supported by a grant from the Science and Technology Foundation of Hubei Province (2003AA301C10)
文摘In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.
文摘The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.
文摘A 77-year-old man with inflammatory bowel disease (IBD) and who was treated with anti-tumor necrosis factor (TNF), 6-mercaptopurine and corticosteroids, presented with primary effusion lymphoma-like lymphoma (PEL-like lymphoma) with massive ascites. The patient’s clinical course was complicated by acute renal insufficiency and hypotension, which led to death within 2 wk. In general, patients with IBD may have an increased risk for development of lymphoma, which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies. PEL is a rare subset of lymphoma localized to serous body cavities, lacks tumor mass or nodal involvement, and is associated with infection by human herpes virus 8 (HHV-8). Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections. This type of lymphoma is classified as PEL-like lymphoma. Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy, but to the best of our knowledge, the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD.
文摘This paper presents the diagnosis of effusion of the knee by ultrasound. 140patients with pain and swelling of the knee were detected to have suprapatellar effusion by ultrasound. The antero-posterior distances of the suprapatellar effusion were 0. 2-3. 4 cm with a mean of 1. 2 cm. The effusion was revealed as an anechoic fluid-filled area in 121 cases (86. 4 %), as a hypoechoic area in 15 cases (10. 7 %), and as a mixed anechoic fluid-filled area and hypoechoic area in remaining 4 (2. 9 %). Of 140 cases of knee effusion, 126 cases were verified by aspiration or operation. The results obtaineddemonstrate that ultrasound can visualize not only the effusion of the knee, but also theabnormalities in the menisci, synovium, and the popliteal fossa ; This provides an important basis for diagnosis and treatment. Further more, ultrasound is painfree, noninvasive, inexpensive, readily acceptable by patients,and convenient for follow-up studles.
文摘Otitis media with effusion(OME)is a frequent paediatric disorder.The condition is often asymptomatic,and so can easily be missed.However,OME can lead to hearing loss that impairs the child's language and behavioural development.The diagnosis is essentially clinical,and is based on otoscopy and(in some cases)tympanometry.Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected.Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart.Hearing must be evaluated(using an age-appropriate audiometry technique)before and after treatment,so as not to miss another underlying cause of deafness(e.g.perception deafness).Craniofacial dysmorphism,respiratory allergy and gastro-oesophageal reflux all favour the development of OME.Although a certain number of medications(antibiotics,corticoids,antihistamines,mucokinetic agents,and nasal decongestants)can be used to treat OME,they are not reliably effective and rarely provide long-term relief.The benchmark treatment for OME is placement of tympanostomy tubes(TTs)and(in some cases)adjunct adenoidectomy.The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear.In contrast,TTs do not prevent progression towards tympanic atrophy or a retraction pocket.Adenoidectomy enhances the effectiveness of TTs.In children with adenoid hypertrophy,adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy.Children must be followed up until OME has disappeared completely,so that any complications are not missed.
文摘AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.
文摘Objective:To evaluate the diagnostic value of endostatin(ES),vascular endothelial growth factor (VEGF) and careinoembryonie antigen(CEA) in both serum and pleural effusion of lung cancer patients.Methods:Levels of ES,VEGF and CEA in 52 malignant pleural effusion due to lung cancer and 50 patients with non-malignant disease were measured by using sandwich enzymelinked immunosorbent assay and microparticle enzyme immunoassay.Results:The ES.VEGF and CEA levels in pleural effusion and serum,and their ratio(F/S) were higher in lung cancer group than that in benign group,and the differences were statistically significant(P【0.05).The diagnostic efficiency of ES+VEGF for lung cancer was superior to either single detection.The diagnostic efficiency of ES+VEGK+CEA was superior to either ES+VEGF or ES+CEA.Conclusions: The results suggest that ES,VEGF and CEA might be useful in the differentiation between benign and malignant pleural effusion due to lung cancer.In comparison with either single determination of concentration in serum or pleural fluid,the couiljined detection of two or three markers is of important clinical significance in the diagnosis of lung cancer.
