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 Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be ...BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.展开更多
Objective: To evaluate the diagnostic significance of detecting cytokeratin 19 (CK19) mRNA by quantitative reverse transcription polymerase chain reaction (RT-PCR) in benign and malignant pleural effusions. Methods: C...Objective: To evaluate the diagnostic significance of detecting cytokeratin 19 (CK19) mRNA by quantitative reverse transcription polymerase chain reaction (RT-PCR) in benign and malignant pleural effusions. Methods: CK19 mRNA was examined by quantitative RT-PCR and CK19 was detected by Enzyme-linked immunoadsorbent assay (ELISA) in 32 patients with malignant pleural effusions and 35 patients with benign pleural effusions. Results: On the threshold of 200 copies/μl, the positive rate of CK19 mRNA in patients with malignant pleural effusions was 62.5%. The positive rates of CK19 mRNA and CK19 in the malignant pleural effusions were significantly higher than those in the benign group (P<0.01). Furthermore, the positive rate of CK19 mRNA was higher than that of CK19 in the malignant group (P<0.05). Conclusion: Detection of CK19 mRNA can be a promising diagnostic marker in differential diagnosis of benign and malignant pleural effusions.展开更多
Background and Aims： Since our rural institution has liamted resources we always choose econoamcal options. Recently, indigenous technique of pleuroscopy is gaining popularity due to various advantages. We developed ...Background and Aims： Since our rural institution has liamted resources we always choose econoamcal options. Recently, indigenous technique of pleuroscopy is gaining popularity due to various advantages. We developed indigenous technique of medical thoracoscopy has been developed and done by using set of patented conduits and fiberoptic bronchoscope （FOB）.Therefore, we have used this technique for undiagnosed pleural effusions. Methods： An observational study was conducted in 79 undiagnosed cases of exudative pleural effusion from June 2016 to Jmmary 2017. Indigenous technique consists of use of fiber optic bronchoscope through various metallic conduits to be used in specified order for medical thoracoscopy. Procedure is done under conscious sedation and conduits are passed one after another in a specified order, through the chest stoma. The visualization of pleural cavity and various procedures were done with FOB （fiberoptic bronchoscope）. Results： Out of the 79 cases, the appearance of pleura showed, inflamed/reddened pleura in 16 （20.2%） cases, thin transparent adhesions in 18 （22.7%）, thin transparent loculations in 16 （20.2%） cases, thick loculations in 6 （7.6%） cases, hard pleural surface in 5 （6.3%）, large nodule/masses in 6 （7.6%）, small amlliary seedlings or sago grain appeoxmlce in 6 （7.6%）, scattered masses or nodules in 5 （6.3%） and, broncho-pleural fistula was observed in 1 （1.2%） case. Histopathological analysis showed chronic inflammation in 34.1% （27）, tubercular lesions in 24.05% （19） of patients. Primary aspergillosis and mesothelioma each has 1 case, and the rest 29.11% （23） were pleural metastasis. Thus, diagnostic yield of pleuroscopy pleural biopsy was 89.9% （71）. Conclusion： Indigenous technique appears to be an efficient and relatively safe procedure with good diagnostic yield in undiagnosed pleural effusions.展开更多
Objective To find out a specific method for diagnosis of malignant pleural effusions (MPEs)with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient cen-trifugation(DGC) ...Objective To find out a specific method for diagnosis of malignant pleural effusions (MPEs)with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient cen-trifugation(DGC) , smear cytologic examination( SCE) and pleural needle biopsy (PNB). Comparisons between these results and those of benign pleural effusions were also made. Results The positive rates of DGC,SCE and PNB for diagnosing MPEs were 94. 3% ,62. 9% and 44. 6% , respectively, and the positive rate of SCE combined with PNB for diagnosing MPEs was 73. 2%. The positive rate of the exfoliative tumor cells ( ETCs ) by DGC was much higher than that of SCE or/and PNB with no false-positive. Conclusion The ETCs isolated by DGC from the MPEs is quite specific for the diagnosis of malignant tumors with higher sensitivity and practicality in clinico-patho-logical practice.展开更多
Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronch...Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy （namely medical thoracoscopy） under local anesthesia for undiagnosed exudative pleural effusions was evaluated . Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups. Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin＇s lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% （25/27）. Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups （P=0.114）. Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and drainage. Medical thoracoscopy could be well tolerated by all the patients. The semi-rigid thoracoscope could be easily controlled by chest physicians. The most common complication was transient chest pain （20 of 27 patients） from the indwelling chest tube, which would be managed with conventional analgesics. One case of subcutaneous emphysema and 2 cases of postoperative fever were self-limiting. No severe complications occurred. Conclusions Medical thoracoscopy is a simple, safe, and cost-effective tool, with a high positive rate. Physicians should extend its access to proper patients if the facilities for medical thoracoscopy are available.展开更多
Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and...Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.展开更多
Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the...Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients （36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion）.The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters （protein, lactate dehydrogenase, glucose and C-reactive protein （CRP）） in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters （protein, lactate dehydrogenase, glucose and CRP）.Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.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
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
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
OBJECTIVE To explore the clinical significance of the human telomerase reverse transcriptase(hTERT)mRNA,CEA and CA19-9 in differential diagnosis of benign and malignant pleural effusions. METHODS Concentrations of CEA...OBJECTIVE To explore the clinical significance of the human telomerase reverse transcriptase(hTERT)mRNA,CEA and CA19-9 in differential diagnosis of benign and malignant pleural effusions. METHODS Concentrations of CEA and CA19-9 in pleural effusions were assayed using automated chemiluminescence,and expression of hTERT mRNA was detected by RT-PCR. RESULTS The positive rates of hTERT mRNA,CEA and CA19-9 expression in the group with malignant effusions were significantly higher compared to the group with benign effusion (P<0.05).The sensitivity(%),specificity(%)and diagnostic accordance rates(%)of the 3 tumor markers were as follows:i) hTERT mRNA:81.8/90.5/86.1;ii)CEA:52.3/92.9/72.1;iii)CA19-9: 34.1/90.5/61.6.The positive rates of hTERT mRNA+CEA(%) expression in the pleural effusions were 97.7. CONCLUSION All of these tumor markers can be helpful for differential diagnosis of pleural effusions.hTERT mRNA had more clinical value in differentiation of the pleural efffusions. CA19-9 is unfit to be as an optimal index.The combined assay of hTERT mRNA and CEA in pleural effusions can further raise the positive detection rate of the tumor markers and can be helpful in producing a diagnosis.展开更多
BACKGROUND: Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factor...BACKGROUND: Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factors. METHODS: From March 2003 to May 2005, 228 consecutive patients with primary liver cancer underwent hepatectomy in our department were evaluated retrospectively to identify factors related to postoperative pleural effusion. RESULTS: Among the 228 patients, postoperative pleural effusions arose in 58 (25.4%). Univariate analysis showed significant differences in postoperative ascites, subphrenic collection, Pringle manoeuvre length, drainage amount on postoperative day 1, albumin level on postoperative day 7, alanine aminotransferase (ALT) level on postoperative days I and 3, prealbumin level on postoperative days 3 and 7, and tumor size (P<0.05). Ordinal regression analysis revealed that subphrenic collection, drainage on postoperative day I and ALT plus prealbumin on postoperative days I and 3 were statistically significantly related to postoperative pleural effusion (P<0.05). CONCLUSION: Subphrenic collection and operative injury to the liver appeared to be significantly related to pleural effusion after hepatectomy for primary liver cancer.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
Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatect...Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied. METHODS:A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements. RESULTS:Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions;whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P<0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis. CONCLUSIONS: Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.展开更多
BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and th...BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.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 pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published ...A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology . Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.展开更多
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 Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.
文摘Objective: To evaluate the diagnostic significance of detecting cytokeratin 19 (CK19) mRNA by quantitative reverse transcription polymerase chain reaction (RT-PCR) in benign and malignant pleural effusions. Methods: CK19 mRNA was examined by quantitative RT-PCR and CK19 was detected by Enzyme-linked immunoadsorbent assay (ELISA) in 32 patients with malignant pleural effusions and 35 patients with benign pleural effusions. Results: On the threshold of 200 copies/μl, the positive rate of CK19 mRNA in patients with malignant pleural effusions was 62.5%. The positive rates of CK19 mRNA and CK19 in the malignant pleural effusions were significantly higher than those in the benign group (P<0.01). Furthermore, the positive rate of CK19 mRNA was higher than that of CK19 in the malignant group (P<0.05). Conclusion: Detection of CK19 mRNA can be a promising diagnostic marker in differential diagnosis of benign and malignant pleural effusions.
文摘Background and Aims： Since our rural institution has liamted resources we always choose econoamcal options. Recently, indigenous technique of pleuroscopy is gaining popularity due to various advantages. We developed indigenous technique of medical thoracoscopy has been developed and done by using set of patented conduits and fiberoptic bronchoscope （FOB）.Therefore, we have used this technique for undiagnosed pleural effusions. Methods： An observational study was conducted in 79 undiagnosed cases of exudative pleural effusion from June 2016 to Jmmary 2017. Indigenous technique consists of use of fiber optic bronchoscope through various metallic conduits to be used in specified order for medical thoracoscopy. Procedure is done under conscious sedation and conduits are passed one after another in a specified order, through the chest stoma. The visualization of pleural cavity and various procedures were done with FOB （fiberoptic bronchoscope）. Results： Out of the 79 cases, the appearance of pleura showed, inflamed/reddened pleura in 16 （20.2%） cases, thin transparent adhesions in 18 （22.7%）, thin transparent loculations in 16 （20.2%） cases, thick loculations in 6 （7.6%） cases, hard pleural surface in 5 （6.3%）, large nodule/masses in 6 （7.6%）, small amlliary seedlings or sago grain appeoxmlce in 6 （7.6%）, scattered masses or nodules in 5 （6.3%） and, broncho-pleural fistula was observed in 1 （1.2%） case. Histopathological analysis showed chronic inflammation in 34.1% （27）, tubercular lesions in 24.05% （19） of patients. Primary aspergillosis and mesothelioma each has 1 case, and the rest 29.11% （23） were pleural metastasis. Thus, diagnostic yield of pleuroscopy pleural biopsy was 89.9% （71）. Conclusion： Indigenous technique appears to be an efficient and relatively safe procedure with good diagnostic yield in undiagnosed pleural effusions.
文摘Objective To find out a specific method for diagnosis of malignant pleural effusions (MPEs)with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient cen-trifugation(DGC) , smear cytologic examination( SCE) and pleural needle biopsy (PNB). Comparisons between these results and those of benign pleural effusions were also made. Results The positive rates of DGC,SCE and PNB for diagnosing MPEs were 94. 3% ,62. 9% and 44. 6% , respectively, and the positive rate of SCE combined with PNB for diagnosing MPEs was 73. 2%. The positive rate of the exfoliative tumor cells ( ETCs ) by DGC was much higher than that of SCE or/and PNB with no false-positive. Conclusion The ETCs isolated by DGC from the MPEs is quite specific for the diagnosis of malignant tumors with higher sensitivity and practicality in clinico-patho-logical practice.
文摘Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy （namely medical thoracoscopy） under local anesthesia for undiagnosed exudative pleural effusions was evaluated . Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups. Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin＇s lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% （25/27）. Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups （P=0.114）. Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and drainage. Medical thoracoscopy could be well tolerated by all the patients. The semi-rigid thoracoscope could be easily controlled by chest physicians. The most common complication was transient chest pain （20 of 27 patients） from the indwelling chest tube, which would be managed with conventional analgesics. One case of subcutaneous emphysema and 2 cases of postoperative fever were self-limiting. No severe complications occurred. Conclusions Medical thoracoscopy is a simple, safe, and cost-effective tool, with a high positive rate. Physicians should extend its access to proper patients if the facilities for medical thoracoscopy are available.
文摘Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.
基金This study was supported in part by research grants from National Natural Science Foundation of China （No.30872343 and No.30660064） and Youth Science Foundation of Guangxi Zhuang Autonomous Region （No.0991034）
文摘Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients （36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion）.The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters （protein, lactate dehydrogenase, glucose and C-reactive protein （CRP）） in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters （protein, lactate dehydrogenase, glucose and CRP）.Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.
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.
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).
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.
基金This work was supported by a grant from the Scientific Fund from the Health Department of Jiangxi province,China(No.2004383)
文摘OBJECTIVE To explore the clinical significance of the human telomerase reverse transcriptase(hTERT)mRNA,CEA and CA19-9 in differential diagnosis of benign and malignant pleural effusions. METHODS Concentrations of CEA and CA19-9 in pleural effusions were assayed using automated chemiluminescence,and expression of hTERT mRNA was detected by RT-PCR. RESULTS The positive rates of hTERT mRNA,CEA and CA19-9 expression in the group with malignant effusions were significantly higher compared to the group with benign effusion (P<0.05).The sensitivity(%),specificity(%)and diagnostic accordance rates(%)of the 3 tumor markers were as follows:i) hTERT mRNA:81.8/90.5/86.1;ii)CEA:52.3/92.9/72.1;iii)CA19-9: 34.1/90.5/61.6.The positive rates of hTERT mRNA+CEA(%) expression in the pleural effusions were 97.7. CONCLUSION All of these tumor markers can be helpful for differential diagnosis of pleural effusions.hTERT mRNA had more clinical value in differentiation of the pleural efffusions. CA19-9 is unfit to be as an optimal index.The combined assay of hTERT mRNA and CEA in pleural effusions can further raise the positive detection rate of the tumor markers and can be helpful in producing a diagnosis.
文摘BACKGROUND: Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factors. METHODS: From March 2003 to May 2005, 228 consecutive patients with primary liver cancer underwent hepatectomy in our department were evaluated retrospectively to identify factors related to postoperative pleural effusion. RESULTS: Among the 228 patients, postoperative pleural effusions arose in 58 (25.4%). Univariate analysis showed significant differences in postoperative ascites, subphrenic collection, Pringle manoeuvre length, drainage amount on postoperative day 1, albumin level on postoperative day 7, alanine aminotransferase (ALT) level on postoperative days I and 3, prealbumin level on postoperative days 3 and 7, and tumor size (P<0.05). Ordinal regression analysis revealed that subphrenic collection, drainage on postoperative day I and ALT plus prealbumin on postoperative days I and 3 were statistically significantly related to postoperative pleural effusion (P<0.05). CONCLUSION: Subphrenic collection and operative injury to the liver appeared to be significantly related to pleural effusion after hepatectomy for primary liver cancer.
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Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied. METHODS:A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements. RESULTS:Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions;whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P<0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis. CONCLUSIONS: Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.
基金Supported by Shaanxi Science and Technology Research Plan Program,Shaanxi,China,No. 2020SF-106
文摘BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.
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 pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology . Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.
