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Merhabene T, Zayet S, Jamoussi A, Ayed S, Mansouri S, Khelil JB, Besbes M. Benefit of intrapleural fibrinolytic therapy in the treatment of complicated parapneumonic effusion and empyema. Pan Afr Med J 2024; 47:54. [PMID: 38646137 PMCID: PMC11032075 DOI: 10.11604/pamj.2024.47.54.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 01/24/2024] [Indexed: 04/23/2024] Open
Abstract
Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1st January 2000 and 31st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.
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Affiliation(s)
- Takoua Merhabene
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Souheil Zayet
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Amira Jamoussi
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Samia Ayed
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Salwa Mansouri
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Jalila Ben Khelil
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Mohamed Besbes
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
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Xu J, Gao L, Yan M, Wang B, Song Z, Liu H, Sun K, Nong L, Wang M, Cen X. Potential Role of Pleural Fluid Cytokine Profile in Myelomatous Pleural Effusions. Onco Targets Ther 2021; 14:4545-4550. [PMID: 34466000 PMCID: PMC8403078 DOI: 10.2147/ott.s324810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Myelomatous pleural effusion (MPE), as a presentation of extramedullary infiltration of multiple myeloma (MM), is rare and currently associated with poor outcomes without effective therapy. The potential value of cytokine detection in pleural effusion to MPE has not been reported to date. Case Presentation We herein report a case of refractory and relapsed multiple myeloma that developed bilateral MPE due to disease progression caused by intolerance to various chemotherapy regimens. Cytomorphology and flow cytometry were adopted for diagnosis confirmation. Chemotherapy containing immunomodulators combined with thoracic catheterization drainage was applied to the patient, showing a certain therapeutic effect. During the course of disease, the change of cytokine profile in pleural effusion was monitored by cytometric bead array (CBA) technology, revealing that cytokines related to tumor load such as interleukin 6 (IL-6) and interleukin 10 (IL-10) in pleural effusion decreased with the improvement of disease, while other cytokines such as interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 17A (IL-17A), tumor necrosis factor α (TNF-α), interferon γ (IFN-γ), granzyme A, granzyme B, perforin and granulysin increased with the improvement of disease. Conclusion There is a prospect that cytokine level in pleural effusion may indicate treatment response of MPE, and in light of this case, immunomodulators may be utilized in treating patients suffering MPE. Due to limitations of our single case, we urge more groups to evaluate the potential role of cytokine profile in MPE.
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Affiliation(s)
- Junhui Xu
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Liang Gao
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Miao Yan
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bingjie Wang
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhengyang Song
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Huihui Liu
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Kunyan Sun
- Department of Respiration, Peking University First Hospital, Beijing, People's Republic of China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, People's Republic of China
| | - Mangju Wang
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
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Zhu LR, Yuan RX, Xia XB, Wang Y, Zhu YM, Fi L, Li J. Assessment of a panel of miRNAs in serum and pleural fluid for the differential diagnosis of malignant and benign pleural effusion. Cancer Biomark 2021; 33:71-82. [PMID: 34366325 DOI: 10.3233/cbm-210090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Differential diagnosis between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains a clinical challenge. OBJECTIVE The aim of the study is to assess the efficacy of the serum and pleural fluid (PF) miRNA panels in distinguishing MPE from BPE. METHODS Fourteen candidate miRNAs which were shown aberrant expression in lung cancer based on previous studies were tested by quantitative real-time PCR (qRT-PCR) in 20 MPE patients and 20 BPE patients. Significantly aberrantly expressed miRNAs were further assessed by qRT-PCR in all patients enrolled in this study. A receiver operating characteristic (ROC) curve was constructed, and the area under the ROC curve (AUC) was calculated to evaluated the diagnostic performance of the miRNAs. RESULTS miR-21, miR-29c and miR-182 were found to be significantly aberrantly expressed in the serum and PF of MPE patients. The AUCs for the combination of miR-21, miR-29c and miR-182 in serum and PF were 0.832 and 0.89 respectively in distinguishing MPE from infection-associated PE including tuberculous pleurisy and parapneumonia PE, and 0.866 and 0.919 respectively for differentiating MPE from heart failure-associated PE, which were superior to AUC of each individual miRNAs. CONCLUSIONS miR-21, miR-29c and miR-182 in serum and PF could be useful biomarkers for MPE of diagnosis.
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Affiliation(s)
- Li-Rong Zhu
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.,Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Rong-Xia Yuan
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.,Department of Respiratory Disease, Yancheng Third People's Hospital, Yancheng, Jiangsu, China.,Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xian-Bin Xia
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yi Wang
- Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu-Min Zhu
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Ling Fi
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jian Li
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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A rapid calprotectin test for the diagnosis of pleural effusion. PLoS One 2021; 16:e0252714. [PMID: 34111153 PMCID: PMC8191907 DOI: 10.1371/journal.pone.0252714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
In previous studies, measuring the levels of calprotectin in patients with pleural effusion (PE) was an exceptionally accurate way to predict malignancy. Here, we evaluated a rapid method for the measurement of calprotectin levels as a useful parameter in the diagnosis of malignant pleural effusion (MPE) in order to minimise invasive diagnostic tests. Calprotectin levels were measured with Quantum Blue® sCAL (QB®sCAL) and compared with the gold standard reference ELISA method. Calprotectin levels in patients with benign pleural effusion (BPE) were significantly higher (p < 0.0001) than for MPE patients. We measured the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LRs) for a cut-off value of ≤ 14,150 ng/mL; the diagnostic accuracy was 64%. The odds ratio for PE calprotectin levels was 10.938 (95% CI [4.133 − 28.947]). The diagnostic performance of calprotectin concentration was better for predicting MPE compared to other individual parameters. Comparison of two assays showed a slope of 1.084, an intercept of 329.7, and a Pearson correlation coefficient of 0.798. The Bland–Altman test showed a positive bias for the QB®sCAL method compared to ELISA fCAL®. Clinical concordance between both these methods was 88.5% with a Cohen kappa index of 0.76 (95% CI [0.68 − 0.84]). We concluded that QB®sCAL is a fast, reliable, and non-invasive diagnostic tool for diagnosing MPE and represents an alternative to ELISA that could be implemented in medical emergencies.
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Matuchova I, Kelbich P, Kubalik J, Hanuljakova E, Stanek I, Maly V, Karpjuk O, Krejsek J. Cytological-energy analysis of pleural effusions with predominance of neutrophils. Ther Adv Respir Dis 2021; 14:1753466620935772. [PMID: 32600177 PMCID: PMC7328477 DOI: 10.1177/1753466620935772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The predominance of neutrophils in pleural effusions of patients with
different serious impairments of the pleural cavity organs is often found.
The aim of this study was to identify the type of injury using the
cytological-energy analysis of pleural effusions. Methods: We analysed 635 samples of pleural effusions with predominance of
neutrophils. We compared the values of the coefficient of energy balance
(KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST)
catalytic activities in the following subgroups of patients: with
transudative effusions, purulent pneumonia, chest empyema and after chest
surgery with and without purulent complications. Statistical analysis was
performed using the ANOVA Kruskal–Wallis test (p < 0.05
was considered as significant). Results: We found the lowest KEB values in pleural effusions of patients with chest
empyema and their gradual increases in patients with purulent pneumonia and
with transudative effusions. We observed the highest LDH and AST enzymes
activity in patients with chest empyema and their gradual decrease in
patients with purulent pneumonia and with transudative effusions. LDH and
AST enzymes activity was significantly higher in pleural effusions of
patients after chest surgery with purulent complications compared with
non-purulent cases. Conclusion: The most intensive inflammation and the most extensive tissue destruction in
the pleural cavity were found in patients with chest empyema. Significantly
better parameters were observed in patients with purulent pneumonia. The
absence of serious inflammation and the absence of tissue destruction were
typical for patients with transudative effusions. Finally, our results
confirmed an anticipated higher tissue destruction in patients after chest
surgery. Significantly worse injury was found in surgical patients with
purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Inka Matuchova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Petr Kelbich
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Socialni pece 3316/12A, 401 13, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Jan Kubalik
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Eva Hanuljakova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Ivan Stanek
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Vilem Maly
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Ondrej Karpjuk
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Jan Krejsek
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic
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Xuan WX, Li JJ, Zhang QC, Sun GN, Xu ZW, Sun ZF, Zhang XJ. Protein expression shift and potential diagnostic markers through proteomics profiling of tuberculous pleurisy biopsy tissues. Int J Infect Dis 2020; 99:245-252. [PMID: 32758691 DOI: 10.1016/j.ijid.2020.07.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Tuberculous pleurisy is a common type of tuberculosis (TB), but its diagnosis is challenging. This study aimed to profile the protein expression of this disease and identify new diagnostic makers. METHODS Biopsy tissues from patients with tuberculous pleurisy and controls were taken through thoracoscopy, and proteins were extracted for Tandem Mass Tag Mass Spectrometry. Differential protein expression was performed between patients and controls, and the identified proteins were analyzed for pathway enrichment. Selected proteins were further validated in another set of samples using a more quantitative method. RESULTS A total of 5101 proteins were detected and quantified in a discovery set of patients and controls. Overall protein expression was quite different between patients and controls. Most proteins were down-expressed, while a minority were overly expressed in the patient samples. At p value < 0.05 and absolute fold change >2, 295 proteins were found to be up-expressed and 608 down-expressed. The top enriched pathways included ECM-receptor interaction, complement and coagulation cascades and focal adhesion. All 19 selected candidates were validated in an independent set of patient and control samples. CONCLUSION This unbiased proteomics approach not only provided unique insights into protein expression and pathways, but also discovered potential diagnostic markers for tuberculous pleurisy.
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Affiliation(s)
- Wei-Xia Xuan
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Jin-Jin Li
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qun-Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guan-Nan Sun
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Wei Xu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Fu Sun
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Xiao-Ju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Bai W, Chen J, Mao Y, Wang Z, Qian X, Hu X, Xu K, Pan Y. A Predictive Model for the Identification of Cardiac Effusions Misclassified by Light's Criteria. Lab Med 2020; 51:370-376. [PMID: 31746342 DOI: 10.1093/labmed/lmz072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The application of Light's criteria misidentifies approximately 30% of transudates as exudates, particularly in patients on diuretics with cardiac effusions. The purpose of this study was to establish a predictive model to effectively identify cardiac effusions misclassified by Light's criteria. METHODS We retrospectively studied 675 consecutive patients with pleural effusion diagnosed by Light's criteria as exudates, of which 43 were heart failure patients. A multivariate logistic model was developed to predict cardiac effusions. The performance of the predictive model was assessed by receiver operating characteristic (ROC) curves, as well as by examining the calibration. RESULTS It was found that protein gradient of >23 g/L, pleural fluid lactate dehydrogenase (PF-LDH) levels, ratio of pleural fluid LDH to serum LDH level (P/S LDH), pleural fluid adenosine deaminase (PF-ADA) levels, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels had a significant impact on the identification of cardiac effusions, and those were simultaneously analyzed by multivariate regression analysis. The area under the curve (AUC) value of the model was 0.953. The model also had higher discriminatory properties than protein gradients (AUC, 0.760) and NT-pro-BNP (AUC, 0.906), all at a P value of <.01. CONCLUSION In cases of suspected cardiac effusion, or where clinicians cannot identify the cause of an exudative effusion, this model may assist in the correct identification of exudative effusions as cardiac effusions.
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Affiliation(s)
- Wenjing Bai
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Jiangnan Chen
- Department of Clinical Laboratory Medicine, Shaoxing Municipal Hospital, Shaoxing, China
| | - Yijian Mao
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Zhihui Wang
- Department of Obstetrics and Gynecology, Wenzhou Central Hospital, Wenzhou, China
| | - Xiaohong Qian
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Xingzhong Hu
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Ke Xu
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
| | - Yong Pan
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, China
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Wong‐Arteta J, Rey M, Aragón L, Gil‐Rodríguez E, Bujanda L. The utility of flow cytometry in the diagnostic work up of malignant effusions due to nonhematopoietic neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:504-515. [PMID: 32506689 DOI: 10.1002/cyto.b.21886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jhonatan Wong‐Arteta
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Hematology Asuncion Clinic Tolosa País Vasco Spain
| | - Mercedes Rey
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Larraitz Aragón
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Eva Gil‐Rodríguez
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
| | - Luis Bujanda
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Gastroenterology Donostia University Hospital San Sebastián País Vasco Spain
- Department of Liver and Gastrointestinal Diseases Biodonostia Health Research Institute San Sebastián País Vasco Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd) Carlos III National Institute of Health Madrid Spain
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Motono N, Iwai S, Funasaki A, Sekimura A, Usuda K, Uramoto H. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond) 2019; 43:29-32. [PMID: 31194145 PMCID: PMC6551566 DOI: 10.1016/j.amsu.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction The management of chest tubes and the volume threshold for chest tube removal after pulmonary resection remain controversial. Several studies have reported the volume threshold for chest tube removal following pulmonary resection to range from 200 to 450 mL/24 h. Methods A prospective randomized single-blind clinical study was performed with data collected from patients who had undergone lobectomy and lymph node dissection at our hospital between June 2014 and April 2018. The patients were randomly assigned to the High group (removal of chest tube when drainage was <450 mL/24 h) or Low group (removal of chest tube when drainage was <200 mL/24 h) at postoperative day (POD) 2. The primary end point was drainage time. The secondary end point were complications and rate of thoracentesis. Results Seventy patients met the inclusion criteria and were randomized, with 35 patients assigned to the High group and 35 patients to the Low group. The average duration of chest tube placement was 2.05 days in the High group and 2.31 days in the Low group. The duration of chest tube placement in the High group was significantly shorter than that in the Low group (p = 0.02). There were no major postoperative complications in either group. Thoracentesis was not necessary in either group. Conclusion Pleural effusion of 450 mL/day is tolerable as the volume threshold for the removal of a chest tube after pulmonary resection.
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10
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Kelbich P, Malý V, Matuchová I, Čegan M, Staněk I, Král J, Karpjuk O, Moudrá-Wünschová I, Kubalík J, Hanuljaková E, Krejsek J. Cytological-energy analysis of pleural effusions. Ann Clin Biochem 2019; 56:630-637. [PMID: 31037951 DOI: 10.1177/0004563219845415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Simultaneous cytological and metabolic investigation of the pleural effusion provides clinically relevant information about the type and intensity of immune response in the pleural cavity. Methods We investigated 1329 pleural effusions from patients with different pathological changes in the pleural cavity. Evaluated parameters were differential cell count of neutrophils, eosinophils, lymphocytes and monocytes, and values of the coefficient of energy balance. Results We found the lowest numbers of cells and the highest coefficient of energy balance values in patients with heart failure and sepsis; relatively high frequency of eosinophils and slightly decreased coefficient of energy balance values in patients with pneumothorax and haemothorax; the predominance of lymphocytes and low coefficient of energy balance values in patients with tuberculous pleuritis; the predominance of neutrophils and variable coefficient of energy balance values in patients after chest surgery; the highest presence of neutrophils and very low coefficient of energy balance values in patients with chest empyema and the predominance of lymphocytes and normal to low coefficient of energy balance values in patients with pleural malignancy. Conclusions Our findings in patients with heart failure and sepsis suggest the absence of inflammation in the pleural cavity. We observed the manifestation of tissue repair in patients with pneumothorax and haemothorax. Patients with tuberculous pleuritis were predominantly characterized by T cell-driven immune response and oxidative burst of macrophages. We found different intensities of immune responses to the chest surgery. The typical finding in patients with empyema was oxidative burst of neutrophils. In patients with pleural malignancy, weak cytotoxic inflammation predominates together with the intensive inflammation characterized by oxidative burst of macrophages.
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Affiliation(s)
- Petr Kelbich
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic.,Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Vilém Malý
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Inka Matuchová
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic.,Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Martin Čegan
- Department of Pathology, Masaryk Hospital Ústí nad Labem, Ústí Labem nad, Czech Republic
| | - Ivan Staněk
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Jiří Král
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Ondřej Karpjuk
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Irena Moudrá-Wünschová
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Jan Kubalík
- Department of Thoracic Surgery, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Eva Hanuljaková
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, Ústí nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Jan Krejsek
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
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11
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Wang C, Peng J, Kuang Y, Zhang J, Dai L. Metabolomic analysis based on 1H-nuclear magnetic resonance spectroscopy metabolic profiles in tuberculous, malignant and transudative pleural effusion. Mol Med Rep 2017. [PMID: 28627685 PMCID: PMC5562006 DOI: 10.3892/mmr.2017.6758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pleural effusion is a common clinical manifestation with various causes. Current diagnostic and therapeutic methods have exhibited numerous limitations. By involving the analysis of dynamic changes in low molecular weight catabolites, metabolomics has been widely applied in various types of disease and have provided platforms to distinguish many novel biomarkers. However, to the best of our knowledge, there are few studies regarding the metabolic profiling for pleural effusion. In the current study, 58 pleural effusion samples were collected, among which 20 were malignant pleural effusions, 20 were tuberculous pleural effusions and 18 were transudative pleural effusions. The small molecule metabolite spectrums were obtained by adopting 1H nuclear magnetic resonance technology, and pattern-recognition multi-variable statistical analysis was used to screen out different metabolites. One-way analysis of variance, and Student-Newman-Keuls and the Kruskal-Wallis test were adopted for statistical analysis. Over 400 metabolites were identified in the untargeted metabolomic analysis and 26 metabolites were identified as significantly different among tuberculous, malignant and transudative pleural effusions. These metabolites were predominantly involved in the metabolic pathways of amino acids metabolism, glycometabolism and lipid metabolism. Statistical analysis revealed that eight metabolites contributed to the distinction between the three groups: Tuberculous, malignant and transudative pleural effusion. In the current study, the feasibility of identifying small molecule biochemical profiles in different types of pleural effusion were investigated reveal novel biological insights into the underlying mechanisms. The results provide specific insights into the biology of tubercular, malignant and transudative pleural effusion and may offer novel strategies for the diagnosis and therapy of associated diseases, including tuberculosis, advanced lung cancer and congestive heart failure.
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Affiliation(s)
- Cheng Wang
- The Second Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Jingjin Peng
- The Second Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Yanling Kuang
- The Second Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Jiaqiang Zhang
- The Second Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Luming Dai
- The Second Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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12
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Apolinário D, Silva J, Loureiro AI, Noya R, Carvalho L. Beyond a pleural effusion: Primary pleuropulmonary sarcomas and the challenge of diagnosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:298-9. [PMID: 27156074 DOI: 10.1016/j.rppnen.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/17/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Apolinário
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - J Silva
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - A I Loureiro
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Noya
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - L Carvalho
- Pathological Anatomy Department, Faculdade de Medicina da Universidade de Coimbra/Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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13
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Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision. PLoS One 2016; 11:e0155398. [PMID: 27171441 PMCID: PMC4865104 DOI: 10.1371/journal.pone.0155398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). METHODS CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN). RESULTS In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. CONCLUSIONS Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.
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