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American Journal of Respiratory and... Mar 2023Sonographic septations are assumed to be important clinical predictors of outcome in pleural infection, but the evidence for this is sparse. The inflammatory and... (Observational Study)
Observational Study
Sonographic septations are assumed to be important clinical predictors of outcome in pleural infection, but the evidence for this is sparse. The inflammatory and fibrinolysis-associated intrapleural pathway(s) leading to septation formation have not been studied in a large cohort of pleural fluid (PF) samples with confirmed pleural infection matched with ultrasound and clinical outcome data. To assess the presence and severity of septations against baseline PF PAI-1 (Plasminogen-Activator Inhibitor-1) and other inflammatory and fibrinolysis-associated proteins as well as to correlate these with clinically important outcomes. We analyzed 214 pleural fluid samples from PILOT (Pleural Infection Longitudinal Outcome Study), a prospective observational pleural infection study, for inflammatory and fibrinolysis-associated proteins using the Luminex platform. Multivariate regression analyses were used to assess the association of pleural biological markers with septation presence and severity (on ultrasound) and clinical outcomes. PF PAI-1 was the only protein independently associated with septation presence ( < 0.001) and septation severity ( = 0.003). PF PAI-1 concentrations were associated with increased length of stay ( = 0.048) and increased 12-month mortality ( = 0.003). Sonographic septations alone had no relation to clinical outcomes. In a large and well-characterized cohort, this is the first study to associate pleural biological parameters with a validated sonographic septation outcome in pleural infection. PF PAI-1 is the first biomarker to demonstrate an independent association with mortality. Although PF PAI-1 plays an integral role in driving septation formation, septations themselves are not associated with clinically important outcomes. These novel findings now require prospective validation.
Topics: Humans; Fibrinolysis; Infections; Plasminogen Activator Inhibitor 1; Pleura; Pleural Diseases; Pleural Effusion; Prospective Studies; Tissue Plasminogen Activator; Ultrasonography
PubMed: 36191254
DOI: 10.1164/rccm.202206-1084OC -
Journal of Bronchology & Interventional... Apr 2022
Topics: Humans; Pancreatic Fistula; Pleural Diseases; Pleural Effusion; Pleurisy; Respiratory Tract Fistula
PubMed: 34907976
DOI: 10.1097/LBR.0000000000000834 -
Jornal Brasileiro de Pneumologia :... May 2022
Topics: Humans; Pancreatic Fistula; Pleural Diseases; Pleural Effusion
PubMed: 35584467
DOI: 10.36416/1806-3756/e20220036 -
Journal of Feline Medicine and Surgery Dec 2019Pleural effusion is a common presenting cause for feline patients in small animal practice. The objectives of this study were to identify possible correlations between...
OBJECTIVES
Pleural effusion is a common presenting cause for feline patients in small animal practice. The objectives of this study were to identify possible correlations between the aetiology of effusion and clinical and laboratory findings.
METHODS
In this retrospective study of 306 cats diagnosed with pleural effusion of established aetiology, cats were divided into six major groups: cardiac disease (CD), feline infectious peritonitis (FIP), neoplasia, pyothorax, chylothorax and miscellaneous. Clinical, laboratory and radiographic parameters were compared between groups.
RESULTS
CD was the most common aetiology (35.3%), followed by neoplasia (30.7%), pyothorax (8.8%), FIP (8.5%), chylothorax (4.6%) and miscellaneous diseases (3.7%). In 26 (8.5%) cats, more than one underlying disease was diagnosed as a possible aetiology for pleural effusion. Cats with FIP were significantly younger than those with CD ( <0.001) and neoplasia ( <0.001). Cats with CD were presented with a significantly lower body temperature compared with cats with FIP ( = 0.022). Cats with CD had significantly higher serum alanine aminotransferase activity compared with all other cats (FIP and pyothorax, <0.001; neoplasia and chylothorax, = 0.02) and serum alkaline phosphatase activity compared with the pyothorax ( <0.001) and FIP groups ( = 0.04), and significantly lower protein concentrations (FIP, pyothorax and neoplasia, <0.001; chylothorax, = 0.04) and nucleated cell counts in the effusion than all other groups (pyothorax and neoplasia, <0.001; chylothorax, = 0.02; FIP, = 0.04). The glucose level in the effusion of cats with pyothorax was significantly lower than glucose levels in patients with CD, neoplasia and chylothorax ( <0.001). Of 249 cats with a follow-up of at least 10 days, 55.8% died or were euthanased during that time.
CONCLUSIONS AND RELEVANCE
CD and neoplasia were the most common causes for feline pleural effusion. Age, liver enzymes, as well as cell count, protein and glucose levels in the effusion can aid in the investigation of underlying aetiologies.
Topics: Animals; Cat Diseases; Cats; Pleural Effusion; Retrospective Studies
PubMed: 30554552
DOI: 10.1177/1098612X18816489 -
BMC Pulmonary Medicine Mar 2021Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate... (Comparative Study)
Comparative Study
PURPOSE
Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate the biomarkers and ratios in serum and pleural fluid (PF) for the differential diagnosis of the multiple types of PE and search for a new diagnostic strategy for PE.
METHODS
In-patients, who developed tuberculous PE (TPE), malignant PE (MPE), complicated parapneumonic effusion (CPPE), uncomplicated PPE (UPPE), or PE caused by connective tissue diseases (CTDs) and underwent thoracentesis at Peking University People's Hospital from November 2016 to April 2019, were included in this study. Eleven biomarkers and their ratios in serum and PF were investigated and compared between pairs of the different PE groups, and a decision-tree was developed.
RESULTS
Totally 112 PE cases, including 25 MPE, 33 TPE, 19 CPPE, 27 UPPE, and 8 PE caused by CTDs, were reviewed. Biomarkers and ratios showed good diagnostic performance with high area under the curve values, sensitivities, and specificities for the differential diagnosis of the multiple types of PE. According to the decision-tree analysis, the combination of adenosine deaminase (ADA), serum albumin, serum lactate dehydrogenase, total protein, PF-LDH/ADA, and PF-LDH/TP provided the best predictive capacity with an overall accuracy of 84.8%; the sensitivity and specificity for TPE diagnosis were 100% and 98.7%, respectively.
CONCLUSION
The biomarkers and ratios showed good diagnostic performance, and a decision-tree with an overall accuracy of 84.8% was developed to differentiate the five types of PE in clinical settings.
Topics: Adenosine Deaminase; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Diagnosis, Differential; Exudates and Transudates; Female; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Pleura; Pleural Effusion; Pleural Effusion, Malignant; Retrospective Studies; Sensitivity and Specificity; Serum Albumin; Thoracentesis; Tuberculosis, Pleural; Young Adult
PubMed: 33740937
DOI: 10.1186/s12890-021-01459-w -
CEN Case Reports Nov 2020Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years... (Review)
Review
Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.
Topics: Adult; Aged; Amyloidosis; Angiotensin Receptor Antagonists; Asbestos; Asian People; Biopsy; Female; Humans; Kidney; Male; Middle Aged; Nephrotic Syndrome; Occupational Exposure; Pleura; Pleural Diseases; Pleural Effusion; Tomography, X-Ray Computed
PubMed: 32535843
DOI: 10.1007/s13730-020-00493-7 -
Scandinavian Journal of Work,... Apr 2001The aim of this study was to verify a clinical impression that patients with coronary heart disease disproportionately frequently have calcified pleural plaques.
OBJECTIVE
The aim of this study was to verify a clinical impression that patients with coronary heart disease disproportionately frequently have calcified pleural plaques.
METHODS
Chest X-rays were collected from 148 patients referred consecutively to the Helsinki University Central Hospital for coronary angiography and from 100 consecutive lung cancer patients seen at the same hospital. The radiographs were analyzed for the presence of calcified pleural plaques according to the classification the International Labour Office. A generalized linear model with binomial distribution and log link was used to estimate the relative risks and their 95% confidence intervals (95% CI).
RESULTS
The prevalence of calcified pleural plaques was 35% for the coronary patients and 19% for the lung cancer patients. Calcified pleural plaques were more common among the men than the women, and the risk increased with age. The relative risk of calcified pleural plaques, adjusted for age and gender, was 2.19 (95% CI 1.44-3.32) for the coronary patients as compared with the lung cancer patients.
CONCLUSIONS
Further studies with better information on past exposure to asbestos and other potential risk factors are warranted to confirm the observations and to examine whether the association between coronary heart disease and calcified pleural plaques is related to an etiologic or an individual susceptibility factor common to both of these conditions.
Topics: Adult; Aged; Aged, 80 and over; Asbestosis; Calcinosis; Coronary Disease; Female; Humans; Linear Models; Lung Neoplasms; Male; Middle Aged; Pleural Diseases; Radiography; Risk Factors
PubMed: 11409599
DOI: 10.5271/sjweh.603 -
European Journal of Radiology Oct 2015Non-cardiac thoracic manifestations of rheumatoid arthritis (RA) cause significant morbidity and mortality among RA patients. Essentially all anatomic compartments in... (Review)
Review
Non-cardiac thoracic manifestations of rheumatoid arthritis (RA) cause significant morbidity and mortality among RA patients. Essentially all anatomic compartments in the chest can be affected including the pleura, pulmonary parenchyma, airway, and vasculature. In addition, treatment-related complications and opportunistic infections are not uncommon. Accurate diagnosis of intra-thoracic disease in an RA patient can be difficult as the radiologic findings may be nonspecific and many of these conditions may coexist. This review article serves to highlight the multitude of RA-related intra-thoracic pathological processes, emphasize differential diagnosis, diagnostic conundrums and discuss how tailoring of CT imaging and image-guided biopsy plays a key role in the management of RA-related pulmonary disease.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Diagnosis, Differential; Humans; Image-Guided Biopsy; Lung Diseases; Opportunistic Infections; Pleural Diseases; Tomography, X-Ray Computed
PubMed: 26210094
DOI: 10.1016/j.ejrad.2015.07.008 -
BMC Pulmonary Medicine Nov 2022Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue... (Comparative Study)
Comparative Study
BACKGROUND
Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications.
METHODS
A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed.
RESULTS
Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2-50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4-8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%).
CONCLUSION
IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.
Topics: Adult; Aged; Humans; Middle Aged; Fibrinolytic Agents; Pleural Diseases; Pleural Effusion; Retrospective Studies; Thrombolytic Therapy; Tissue Plasminogen Activator
PubMed: 36419155
DOI: 10.1186/s12890-022-02239-w -
The Journal of Thoracic and... Mar 2002The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these...
OBJECTIVE
The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients.
METHODS
Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years.
RESULTS
The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence.
CONCLUSIONS
Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Echinococcosis; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumothorax; Retrospective Studies
PubMed: 11882820
DOI: 10.1067/mtc.2002.119341