Pour voir les autres types de publications sur ce sujet consultez le lien suivant : Effusion.
Articles de revues sur le sujet « Effusion »
Créez une référence correcte selon les styles APA, MLA, Chicago, Harvard et plusieurs autres
Consultez les 50 meilleurs articles de revues pour votre recherche sur le sujet « Effusion ».
À côté de chaque source dans la liste de références il y a un bouton « Ajouter à la bibliographie ». Cliquez sur ce bouton, et nous générerons automatiquement la référence bibliographique pour la source choisie selon votre style de citation préféré : APA, MLA, Harvard, Vancouver, Chicago, etc.
Vous pouvez aussi télécharger le texte intégral de la publication scolaire au format pdf et consulter son résumé en ligne lorsque ces informations sont inclues dans les métadonnées.
Parcourez les articles de revues sur diverses disciplines et organisez correctement votre bibliographie.
1
Bates, Davina, Natalie Yang, Michael Bailey et Rinaldo Bellomo. « Prevalence, characteristics, drainage and outcome of radiologically diagnosed pleural effusions in critically ill patients ». Critical Care and Resuscitation 22, no 1 (2 mars 2020) : 45–52. http://dx.doi.org/10.51893/2020.1.oa5.
Texte intégralRésumé :
OBJECTIVE: Pleural effusions in the intensive care unit (ICU) are clinically important. However, there is limited information regarding effusions in such patients. We aimed to estimate the prevalence, patient characteristics, mortality, effusion duration, radiological resolution, drainage, and reaccumulation rates of pleural effusions in ICU patients. METHODS: This retrospective cohort study assessed all patients admitted to a tertiary hospital ICU from 1 January to 31 December 2015 with a chest x-ray report of pleural effusion. All chest x-ray reports were reviewed and data were combined with an established clinical ICU database. Statistical analysis of the combined dataset was performed. RESULTS: Among 2094 patients admitted to the ICU, 566 (27%) had pleural effusions diagnosed by chest x-ray. The effusion median duration was 3 days (IQR, 1–5 days). Radiologically documented clearance of the effusion occurred in 243 patients (43%) and drainage was performed in 52 patients (9%). Among patients with effusion clearance, 80 (33%) reaccumulated the effusion. Drainage was more common in patients who experienced reaccumulation (19% v 7%; P = 0.004). Overall, 89 patients (16%) died, with 20% mortality among those with reaccumulation versus 9% among patients without reaccumulation (P = 0.037). CONCLUSION: Pleural effusions are common in ICU patients and drainage is infrequent. One-third of effusions reaccumulate, even after drainage, and one in six patients with an effusion die in hospital. This information helps clinicians estimate resolution rates, advantages and disadvantages of effusion drainage, and overall prognosis.
2
Desai, Vishal K., et Rashmi S. Arora. « Profile of exudative pleural effusion in the region of Bhuj people ». International Journal of Advances in Medicine 5, no 4 (23 juillet 2018) : 1057. http://dx.doi.org/10.18203/2349-3933.ijam20183147.
Texte intégralRésumé :
Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.
3
Creaney, Jenette, Amanda Segal, Nola Olsen, Ian M. Dick, A. W(Bill) Musk, Steven J. Skates et Bruce W. Robinson. « Pleural Fluid Mesothelin as an Adjunct to the Diagnosis of Pleural Malignant Mesothelioma ». Disease Markers 2014 (2014) : 1–10. http://dx.doi.org/10.1155/2014/413946.
Texte intégralRésumé :
Rationale. The diagnosis of pleural malignant mesothelioma (MM) by effusion cytology may be difficult and is currently controversial. Effusion mesothelin levels are increased in patients with MM but the clinical role of this test is uncertain.Objectives. To determine the clinical value of measuring mesothelin levels in pleural effusion supernatant to aid diagnosis of MM.Methods and Measurements. Pleural effusion samples were collected prospectively from 1331 consecutive patients. Mesothelin levels were determined by commercial ELISA in effusions and their relationship to concurrent pathology reporting and final clinical diagnosis was determined.Results. 2156 pleural effusion samples from 1331 individuals were analysed. The final clinical diagnosis was 183 MM, 436 non-MM malignancy, and 712 nonmalignant effusions. Effusion mesothelin had a sensitivity of 67% for MM at 95% specificity. Mesothelin was elevated in over 47% of MM cases in effusions obtained before definitive diagnosis of MM was established. In the setting of inconclusive effusion cytology, effusion mesothelin had a positive predictive value of 79% for MM and 94% for malignancy.Conclusions. A mesothelin-positive pleural effusion, irrespective of the identification of malignant cells, indicates the likely presence of malignancy and adds weight to the clinical rationale for further investigation to establish a malignant diagnosis.
4
Monappa, Vidya, Saritha M. Reddy et Ranjini Kudva. « Hematolymphoid neoplasms in effusion cytology ». CytoJournal 15 (14 juin 2018) : 15. http://dx.doi.org/10.4103/cytojournal.cytojournal_48_17.
Texte intégralRésumé :
Background: Hematolymphoid neoplasms (HLNs) presenting as body cavity effusions are not a common finding. They may be the first manifestation of the disease. A diagnosis on effusion cytology may provide an early breakthrough for effective clinical management. Aims: Study the cytomorphology of HLNs in effusion cytology, determine common types, sites involved and uncover useful cytomorphologic clues to subclassify them. Materials and Methods: Twenty-four biopsy-proven HLN cases with malignant body cavity effusions and 8 cases suspicious for HLN on cytology but negative on biopsy are included in this study. Effusion cytology smears were reviewed for cytomorphological features: cellularity, cell size, nuclear features, accompanying cells, karyorrhexis, and mitoses. Results: Diffuse large B-cell lymphoma (37%) was the most common lymphoma type presenting as effusion followed by peripheral T-cell lymphoma (25%). Pleural effusion (75%) was most frequent presentation followed by peritoneal effusion (20.8%). Pericardial effusion was rare (4.1%). The common cytologic features of HLNs in effusions: high cellularity, lymphoid looking cells with nuclear enlargement, dyscohesive nature, and accompanying small lymphocytes. Mitosis and karyorrhexis were higher in high-grade HLNs when compared to low-grade HLNs. Myelomatous effusion showed plasmacytoid cells. Very large, blastoid looking cells with folded nuclei, high N: C ratio, and prominent nucleoli were seen in leukemic effusion. Conclusion: HLNs have characteristic cytomorphology and an attempt to subclassify them should be made on effusion cytology. Reactive lymphocyte-rich effusions cannot be distinguished from low-grade lymphomas based on cytomorphology alone. Ancillary tests such as immunocytochemistry, flow cytometry, and/or molecular techniques may prove more useful in this regard.
5
Jha, Anil Kumar, J. B. Singh et S. P. Raut. « MICROORGANISMS IN CHRONIC OTITIS MEDIA WITH EFFUSION ». Journal of Nepal Medical Association 41, no 142 (1 janvier 2003) : 314–17. http://dx.doi.org/10.31729/jnma.753.
Texte intégralRésumé :
A total of 100 patient with otitis media effusion obtained from patients suffering fromchronic otitis media with effusions was examined for bacterial smear and culture. Inmucoid effusion 82% showed positive bacterial smear, only 35% yielded positivebacterial culture. Bacterial cultures rate was higher in serous (50%) effusion. Theisolation of common pathogens accounted for the remaining 42%. The high incidenceof microorganisms in the middle ear effusions in the present study indicates bacterialcontribution in many cases of otitis media effusion. Concerning the sterile nature ofthe middle ear fluid some investigators suggested that the effusions are transudatesand are created by a negative pressure in the tympanum due to a malfunctioningEustachian tube.2It was suggested that failure to isolate organisms may be partly dueto the antimicrobial characteristics of effusions. The purpose of this study is to showpossible role of bacteria in Middle Ear Effusions.Key Words: Otitis Media, Effusion, Microorganisms.
6
Chandel, Abhimanyu, Alison Verster, Husna Rahim, Vikramjit Khangoora, Steven D. Nathan, Kareem Ahmad, Shambhu Aryal et al. « Incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension ». Pulmonary Circulation 11, no 2 (avril 2021) : 204589402110123. http://dx.doi.org/10.1177/20458940211012366.
Texte intégralRésumé :
It has been suggested pleural effusions may develop in right heart failure in the absence of left heart disease. The incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension is uncertain. Patients with pulmonary arterial hypertension followed at our tertiary care center were reviewed. Survival was examined based on the subsequent development of a pleural effusion. A total of 191 patients with pulmonary arterial hypertension met the inclusion criteria. The prevalence of pleural effusions on initial assessment was 7.3%. Among patients without a pleural effusion on initial imaging and at least one follow-up computerized tomography ( N = 142), pleural effusion developed in 27.5% ( N = 39) of patients. No alternative etiology of the effusion was identified in 19 (48.7%) cases and effusions deemed related to pulmonary arterial hypertension occurred at an incident rate of 38.6 cases per 1000 person-years. Of these, 14 (73.7%) were bilateral, 3 (15.8%) were right-sided, and 2 (10.5%) were left-sided. Effusion size was trace or small in 18 patients (94.7%). Development of a new pleural effusion was associated with attenuated survival in unadjusted survival analysis (HR: 3.80; 95% CI: 1.55–9.31), multivariate analysis (HR: 5.13; 95% CI: 1.86–14.16), and after the multivariate model was adjusted for concomitant pericardial effusion (HR: 4.86; 95% CI: 1.51–15.71). Negative impact on survival remained unchanged when effusions more likely related to an alternative cause were removed from analysis. In conclusion, pleural effusions can complicate pulmonary arterial hypertension in the absence of left heart disease. These effusions are frequently small in size, bilateral in location, and their presence is associated with decreased survival. Attenuated survival appears independent of the risk associated with a new pericardial effusion.
7
Stenfors, Lars-Eric, et Simo Räisänen. « Quantitative analysis of the bacterial findings in otitis media ». Journal of Laryngology & ; Otology 104, no 10 (octobre 1990) : 749–57. http://dx.doi.org/10.1017/s0022215100113842.
Texte intégralRésumé :
AbstractQualitative and quantitative bacterial analysis of 200 samples of middle ear effusions collected from patients with current otitis media was performed. When middle ear pathogens (S. pneumoniae, H. influenzaeandB. catarrhalis) where found during current acute otitis media or otitis media with effusion infection, the quantity of these bacteria was of the magnitude 106–108/ml and 0–5 × 105/ml effusion material, respectively. Mucopurulent effusion material contained 6 × 105–108bacteria per ml whereas effusion from chronically discharging ears exceeded 109bacteria per ml. Serous effusions did not harbour middle ear pathogens. The appearance of the effusion material was dependent on the number of bacteria involved. Quantification of bacteria in various middle ear effusions offers opportunities to make the diagnosis of various otitis media infections more accurate and readily comparable.
8
ALEMÁN, Carmen, José ALEGRE, Jasone MONASTERIO, Rosa M. SEGURA, Lluís ARMADANS, Ana ANGLÉS, Encarna VARELA, Eva RUIZ et Tomás FERNÁNDEZ DE SEVILLA. « Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions ». Clinical Science 105, no 5 (1 novembre 2003) : 601–7. http://dx.doi.org/10.1042/cs20030115.
Texte intégralRésumé :
The response of the fibrinolytic system to inflammatory mediators in empyema and complicated parapneumonic pleural effusions is still uncertain. We prospectively analysed 100 patients with pleural effusion: 25 with empyema or complicated parapneumonic effusion, 22 with tuberculous effusion, 28 with malignant effusion and 25 with transudate effusion. Inflammatory mediators, tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8) and polymorphonuclear elastase, were measured in serum and pleural fluid. Fibrinolytic system parameters, plasminogen, tissue-type plasminogen activator (t-PA) and urokinase PA, PA inhibitor type 1 (PAI 1) and PAI type 2 concentrations and PAI 1 activity, were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test was used to compare plasma and pleural values and to compare pleural values according to the aetiology of the effusion. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid. Significant differences were found between pleural and plasma fibrinolytic system levels. Pleural fluid exudates had higher fibrinolytic levels than transudates. Among exudates, tuberculous, empyema and complicated parapneumonic effusions demonstrated higher pleural PAI levels than malignant effusions, whereas t-PA was lowest in empyema and complicated parapneumonic pleural effusions. PAI concentrations correlated with TNF-α, IL-8 and polymorphonuclear elastase when all exudative effusions were analysed, but the association was not maintained in empyema and complicated parapneumonic effusions. A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions. Blockage of fibrin clearance in empyema and complicated parapneumonic effusions was associated with both enhanced levels of PAIs and decreased levels of t-PA.
9
Saliya, Maulik P., et Gurudutt S. Joshi. « Profile of children with pleural effusion in an urban tertiary care hospital ». International Journal of Contemporary Pediatrics 4, no 5 (23 août 2017) : 1857. http://dx.doi.org/10.18203/2349-3291.ijcp20173799.
Texte intégralRésumé :
Background: Management of pleural effusions depends on their origin whether exudates or transudates, simple or complicated with septations and pneumonia. A complicated effusion requires longer treatment. This study was carried out to find out types of effusion and their etiology.Methods: A Prospective study of 34 patients was analyzed for clinical and laboratory profile, origin and type of fluid, etiology of pleural effusion in pediatric patients.Results: Majority of the patients were in 6-11 years age group. Fever and cough were most common clinical symptoms in all type of effusion. Parapneumonic effusion was most common type of effusion followed by tuberculosis and empyema. Almost all exudates satisfied Lights criteria.Conclusions: Pleural effusions are mostly exudative in origin in pediatric age and are associated with consolidation and septations especially in empyema. In tubercular Pleural effusion, Sputum for AFB was positive in more number of patients as compared to CBNAAT in this study.
10
Fagere, Muaz, Shawgi Elsiddig, Anass Abbas, Manar Shalabi et Asaad Babker. « Serous Effusion Cytology in Sudanese Patients ». International Journal of Biomedicine 12, no 1 (10 mars 2022) : 160–63. http://dx.doi.org/10.21103/article12(1)_oa20.
Texte intégralRésumé :
The purpose of this study was to determine the etiology and cytological patterns of serous effusions among Sudanese patients. Methods and Results: This descriptive study was carried out in hospitals of Khartoum state in the period from February 2019 to June 2020. One hundred and seventy-eight patients “clinically and/or radiological” diagnosed as having an accumulation of serous effusions were included in this study. Smears were prepared and stained according to the conventional pap staining procedure. The majority of the study population (121[68%]) had malignant effusion (MEs), and the other group (57[32%]) - benign effusions (BEs). Among patients with MEs, breast cancer was the major etiology (75[62%]), followed by lung (23[19%]), GIT (12[9.9%]), and thyroid cancers (11[9.1%]), while among patients with BEs, parapneumonic conditions were the main factor (28[49.1%]), followed by tuberculosis (18[31.6%]) and pulmonary embolism (11[19.3%]). The majority of patients with MEs were pleural effusion (109[90.1%]), followed by peritoneal effusion (12[9.9%]), whereas no patients in this group had pericardial effusion. Pleural effusion (29[50.9%]) was also the major one among patients with BEs, followed by peritoneal (21[36.8%]) and pericardial effusions(7[3.9%]). Conclusion: Malignant serous effusion is commonly seen among patients with malignant tumors; pleural effusions presented a large proportion, especially among females with breast cancer. Thoracentesis and cytological methods (i.e., conventional smear and cell block technique) should be the first line for the diagnosis of malignant pleural effusions, along with confirmatory adjunct techniques such as immunohistochemistry and immunocytochemistry.
11
Wittstein, Jocelyn, Charles Spritzer et William E. Garrett. « MRI Determination of Knee Effusion Volume : A Cadaveric Study ». Duke Orthopaedic Journal 3, no 1 (2013) : 67–70. http://dx.doi.org/10.5005/jp-journals-10017-1032.
Texte intégralRésumé :
ABSTRACT Background There is currently limited literature on quantitative determination of knee effusion volume using magnetic resonance imaging (MRI). Purpose To describe a method of knee effusion volume determination using MRI generated models and to demonstrate accuracy of this technique. Materials and methods Using axial T2-weighted turbo spin echo and sagittal SPACE sequences, MRIs of three cadaver knees with multiple saline loads were obtained. Effusions models were created and effusion volumes were estimated using the Rhinoceros software. Estimated and known effusion volumes were compared using a bivariate correlation analysis. Results The SPACE sequence and T2WTSE estimates were highly correlated with the known volumes (R = 0.996 and 0.993 respectively, p < 0.001). Conclusion MRI-generated models of knee effusions provide accurate estimates of knee effusion volumes. Clinical relevance MRI determination of knee effusion volume may provide a useful clinical outcomes tool. Wittstein J, Spritzer C, Garrett WE. MRI Determination of Knee Effusion Volume: A Cadaveric Study. The Duke Orthop J 2013;3(1):67-70.
12
Maksimovic, Tamara, Aljosa Mandic, Sinisa Maksimovic, Ivan Kuhajda, Milorad Bijelovic et Nemanja Stevanovic. « Malignant pleural effusion in patients with ovarian cancer ». Medical review 75, no 1-2 (2022) : 45–49. http://dx.doi.org/10.2298/mpns2202045m.
Texte intégralRésumé :
Introduction. Ovarian cancer is the most lethal gynecological cancer. The most common manifestation of thoracic metastasis is pleural effusion. Pleural effusion with positive cytology is regarded as stage IVa of the International Federation of Gynecology and Obstetrics classification, and the overall five-year survival in these patients is less than 20%. We analyzed the data of patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina, in order to establish the incidence of malignant pleural effusions, laterality of pleural effusions, and clinical manifestations. Material and Methods. The study included 731 patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina from January 2012 to May 2020. The obtained data were compared with data found in the literature in the same period. Results. The incidence of malignant pleural effusion in our study was 5.75%; right-sided pleural effusion was found in 57.15% of patients, 33.33% of patients had effusion on the left side, and 9.52% had bilateral effusions. Thus, unilateral effusion was found in 90.48% of cases, and bilateral in only 9.52%. The most common symptom was dyspnea, reported in 33 patients (78.6%). Conclusion. The incidence of malignant pleural effusion in our study was most similar to data found by Zamboni et al. published in 2015; the right side was the dominant side of pleural effusions. The most common symptoms were dyspnea, shortnes of breath and chest pain.
13
Wang, Sing-Ting, Chieh-Lung Chen, Shih-Hsin Liang, Shih-Peng Yeh et Wen-Chien Cheng. « Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase : A case report and review of literature ». Open Medicine 16, no 1 (1 janvier 2021) : 387–96. http://dx.doi.org/10.1515/med-2021-0243.
Texte intégralRésumé :
Abstract Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.
14
DeBiasi, Erin M., Margaret A. Pisani, Terrence E. Murphy, Katy Araujo, Anna Kookoolis, A. Christine Argento et Jonathan Puchalski. « Mortality among patients with pleural effusion undergoing thoracentesis ». European Respiratory Journal 46, no 2 (2 avril 2015) : 495–502. http://dx.doi.org/10.1183/09031936.00217114.
Texte intégralRésumé :
Of the 1.5 million people diagnosed with pleural effusion in the USA annually, ∼178 000 undergo thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied.This prospective cohort study evaluated 308 patients undergoing thoracentesis. Chart review was performed to obtain baseline characteristics. The aetiology of the effusions was determined using standardised criteria. Mortality was determined at 30 days and 1 year.247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1-year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign aetiologies (29% and 55%), congestive heart failure (22% and 53%), and renal failure (14% and 57%, respectively). Patients with bilateral, relative to unilateral, pleural effusion were associated with higher risk of death at 30 days and 1 year (17% versus 47% (hazard ratio (HR) 2.58, 95% CI 1.44–4.63) and 36% versus 69% (HR 2.32, 95% CI 1.55–3.48), respectively).Patients undergoing thoracentesis for pleural effusion have high short- and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign aetiologies, congestive heart failure and renal failure. Bilateral pleural effusion is distinctly associated with high mortality.
15
Hoppmann, Richard, Patrick Hunt, Hunter Louis, Brian Keisler, Nancy Richeson, Victor Rao, Jason Stacy et Duncan Howe. « Medical Student Identification of Knee Effusion by Ultrasound ». ISRN Rheumatology 2011 (11 avril 2011) : 1–3. http://dx.doi.org/10.5402/2011/874596.
Texte intégralRésumé :
Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.
16
DOMEJ, Wolfgang, Gernot Peter TILZ, Zeno FÖLDES-PAPP, Ulrike DEMEL, Thomas RABOLD et Herwig HOLZER. « Cystatin C of pleural effusion as a novel diagnostic aid in pleural diseases of different aetiologies ». Clinical Science 102, no 3 (14 février 2002) : 373–80. http://dx.doi.org/10.1042/cs1020373.
Texte intégralRésumé :
There has been considerable recent interest in the potential use of serum cystatin C as a diagnostic tool. Here we examined the hypothesis that the cystatin C level in the pleural effusion can differ from the corresponding serum level. We evacuated pleural effusion fluids from 47 patients by thoracentesis. Cystatin C, β2-microglobulin, inorganic phosphate, creatinine and total protein were quantified in both pleural effusion fluids and corresponding sera. We determined cystatin C levels in pleural effusions and calculated the ratio of cystatin C levels in serum and effusion, to discriminate between effusions caused by severe renal impairment and other types of effusion. Extremely high concentrations of cystatin C in serum/effusion pairs were only measured in patients with renal failure (6.0±0.8/6.0±0.8mg/l, means±S.D., n = 11). A clearly defined region was found to correspond to pleural effusion caused by renal failure (r = 0.954). The quantification of cystatin C in the effusion was justified by the discovery that there were some patients with a high serum cystatin C level but a low effusion concentration, or a low serum cystatin C but a high effusion concentration, indicating causes other than renal failure. In conclusion, the pilot data indicate a relationship between the cystatin C concentration in pleural fluid and the underlying disease. Thus cystatin C levels in pleural effusion and serum may be a valuable criterion for the differential diagnosis of pleural diseases of different aetiologies.
17
Marinkovic, Sanja Petrusevska, Irena Kondova Topuzovska, Milena Stevanovic et Ankica Anastasovska. « Features of Parapneumonic Effusions ». PRILOZI 39, no 1 (1 juillet 2018) : 131–41. http://dx.doi.org/10.2478/prilozi-2018-0033.
Texte intégralRésumé :
Abstract Introduction: Parapneumonic effusions, as a complication of community-acquired pneumonia (CAP), usually have a good course, but they sometimes progress into complicated parapneumonic effusion (CPPE) and empyema, thus becoming a significant clinical problem. Aim: To review clinical and radiological features, as well as diagnostic and therapeutic options in parapneumonic effusions. Material and methods: The analysis included 94 patients with parapneumonic effusion hospitalized at the University Infectious Diseases Clinic in Skopje during a 4 year period. Out of 755 patients with CAP, 175 (23.18%), had parapneumonic effusion. Thoracentesis was performed in 94 (53.71%) patients, 50 patients were with uncomplicated parapneumonic effusions (UCPPE) and 44 with complicated parapneumonic effusions (CPPE). Results: More patients (59.57%) were male; the average age was 53.82±17.5 years. The most common symptoms included: fever (91; 96.81%), cough (80; 85.11%), pleuritic chest pain (68; 72.34%), dyspnea (65; 69.15%). Alcoholism was the most common comorbidity registered in 12 (12.77%) patients. Macroscopically, effusion was yellow and clear in most cases (36; 38.29%). Localization of pleural effusion was often in the left costophrenic angle (53; 56.38%) and ultrasonographic non-septated complex. Between the two groups of effusions there was a significant difference between the ERS, WBC and CRP in serum and CRP in pleural fluid. Statistical difference existed in terms of days of hospitalization with a longer hospital stay for patients with CPPE (p <0.0001). Conclusion: Patients with parapneumonic effusion have the symptoms of acute respiratory infection and frequent accompanying diseases. Future diagnostic and therapeutic treatment depends on pleural fluid features and imaging lung findings.
18
Takeuchi, Kazuhiko, Yuichi Majima, Masahiko Hattori, Keisuke Hirata et Yasuo Sakakura. « Quantitation of Tubotympanal Mucociliary Clearance in Otitis Media with Effusion ». Annals of Otology, Rhinology & ; Laryngology 99, no 3 (mars 1990) : 211–14. http://dx.doi.org/10.1177/000348949009900310.
Texte intégralRésumé :
In an attempt to analyze the tubotympanal mucociliary function in otitis media with effusion (OME), human serum albumin labeled with technetium 99m was instilled into 36 ears with effusion and 16 without. The clearance function of the tubotympanum was measured quantitatively. The viscoelasticity of the effusions was measured and was compared with the clearance rate. The clearance rate was significantly lower in ears with effusion than in those without. A significant negative correlation was observed between clearance rate and dynamic viscosity at dynamic viscosities above 2 poise. It is concluded that ears with effusion have significantly lower mucociliary clearance than those without, and that the viscosity of the effusions plays an important role in the mucociliary dysfunction in OME.
19
Lindner, Moritz, Richard Thomas, Brian Claggett, Eldrin F. Lewis, John Groarke, Allison A. Merz, Montane B. Silverman et al. « Quantification of pleural effusions on thoracic ultrasound in acute heart failure ». European Heart Journal : Acute Cardiovascular Care 9, no 5 (24 janvier 2020) : 513–21. http://dx.doi.org/10.1177/2048872620901835.
Texte intégralRésumé :
Background: Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. Methods: In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. Results: Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score ( P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography ( P<0.001), higher NT-pro brain natriuretic peptide values ( P=0.001) and a greater number of B-lines on lung ultrasound ( P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11–5.37; P=0.027). Conclusion: Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.
20
Copeland, Samuel, Audra Schwalk, Salkowan Suchartlikitwong, Shengping Yang et Gilbert Berdine. « Indwelling pleural catheters for recurrent pleural effusions : A useful clinical tool with serious implications ». Southwest Respiratory and Critical Care Chronicles 6, no 25 (20 juillet 2018) : 8–13. http://dx.doi.org/10.12746/swrccc.v6i25.477.
Texte intégralRésumé :
Background: Indwelling pleural catheters (IPC) have been used increasingly in patients with recurrent pleural effusions. However, data about mortality after IPC use are limited. Objectives: We sought to determine the natural history following IPC placement in Lubbock, Texas, in terms of life expectancy and pleurodesis rates in patients with both malignant and benign effusions. Methods: A retrospective review of patients who had IPC insertion from March 2014 through December 2016 at University Medical Center in Lubbock, Texas, was performed. Patients 18 years and older who had IPC placement for recurrent pleural effusions were included. The duration of IPC placement, the type of pleural effusion, the volume of fluid, pleurodesis, complications, and mortality after IPC placement were retrieved from electronic medical records. Results: There were 45 patients included in the study; 20 patients (44%) were male, and 25 patients (56%) were female. The mean age was 63.5 years old. There were 33 patients with malignant pleural effusion and 12 patients with benign pleural effusion. No patients with malignant effusion were known to be alive at the time of mortality calculation, whereas two patients with benign effusion were known to be alive. Median survival was 468 days in the benign effusion group and 115 days in the malignant effusion group. The 30-day mortality was not significantly different between the two groups (malignant 34.5% vs. benign 25.0%). However, 1-year mortality was significantly higher in the malignant effusion group (89.7%) than in the benign effusion group (41.7%) (p < 0.005). Conclusion: The use of indwelling pleural catheters in Lubbock, Texas, has comparable results to published studies. These catheters should be considered as a bridge to a long-term treatment rather than a definitive therapy.
21
Lambert, Paul R. « Oral Steroid Therapy for Chronic Middle Ear Perfusion : A Double-Blind Crossover Study ». Otolaryngology–Head and Neck Surgery 95, no 2 (septembre 1986) : 193–99. http://dx.doi.org/10.1177/019459988609500211.
Texte intégralRésumé :
A prospective, double-blind crossover study design was used in the evaluation of the role of prednisone in the treatment of a chronic middle ear effusion. Sixty children with an effusion—of at least 2 months’ duration—randomly received either prednisone or placebo for 2 weeks. One week later they were re-evaluated. If the effusion had resolved, they were followed periodically; if the effusion persisted, they were given the crossover regimen and reevaluated. Sixty percent of the patients’ effusions cleared, but there was no statistical difference between the prednisone and placebo groups. The amount of hearing recovery was also the same for both treatment regimens. Subdividing the patients on the basis of effusion duration, unilateral vs. bilateral effusions, or history of ventilation tubes or antibiotics failed to identify a subgroup of individuals who might benefit from a short-term course of oral steroids.
22
Rankovic, Bosko, et Ruzica Djordjevic. « Diagnostic importance of zinc in the clarification of pleural effusions etiology ». Vojnosanitetski pregled 59, no 4 (2002) : 385–87. http://dx.doi.org/10.2298/vsp0204385r.
Texte intégralRésumé :
Concentration of zinc in blood serum and effusion was determined in 104 patients with the pleural effusion of different etiology. The importance of zinc concentration in serum and effusion was analyzed, as well as their relation regarding the differential diagnosis of pleural effusion. It was established that the isolated zinc concentrations in serum and pleural effusion could not be used separately either in differing transudates from exudates or in the diagnosis of the pleural diseases. The average value of zinc in the pleural effusion in relation to the serum value in patients with tuberculosis effusion was 1.37, higher than 1 in all patients and was significantly different from the average value of the ratio 0,74 in patients with nonspecific and malignant pleural effusions. The relation of zinc concentration in the effusion and serum higher than 1.0 reliably indicated the presence of tuberculous pleurisy.
23
Uddin, Kazi Shihab, Md Mahbub Rashid Sarker, Md Abdur Razzaque et Md Zulfikar Ali. « Pleural fluid cytology, biochemistry and adenosine deminase level study in differentiating tubercular and non tubercular causes of pleural effusion ». KYAMC Journal 9, no 1 (9 mai 2018) : 28–31. http://dx.doi.org/10.3329/kyamcj.v9i1.36620.
Texte intégralRésumé :
Background: Adenosine deaminase (ADA) level in pleural fluid study has gained popularity for quick diagnosis and treatment of tuberculous pleural effusion in tuberculosis burden countries. Studies have confirmed high sensitivity and specificity across the world. Pleural fluid cytology, biochemistry and malignant cell examinations are already in use and widely available.Objectives: Diagnostic approach to quickly differentiate between tubercular and non tubercular pleural effusions by analyzing cytology, biochemistry and ADA level.Materials & Methods: This study was carried out on 85 patients who were admitted or visited outpatient department with pleural effusion. The pleural fluid study was including measurement of ADA level was done.Results: 41 cases were diagnosed as tubercular pleural effusion. Among the low ADA group, 9 cases were diagnosed as malignant pleural effusion with positive malignant cell and 13 cases were transudative effusion.7 cases were diagnosed as parapneumonic effusion with exudative fluid, neutrophilic cell distribution and mixed ADA activity.Conclusion: ADA was found positive with a mean value of 88.3 U/L in tubercular pleural effusions. Non tubercular pleural effusion showed low ADA level. However the cytological and biochemical examination of pleural fluid was also found to be important in differentiating tubercular from non tubercular causes.KYAMC Journal Vol. 9, No.-1, April 2018, Page 28-31
24
Lacy, Mark. « Eosinophilic pleural effusion : A case and a review ». Southwest Respiratory and Critical Care Chronicles 8, no 33 (9 février 2020) : 40–46. http://dx.doi.org/10.12746/swrccc.v8i33.633.
Texte intégralRésumé :
A previously healthy middle-aged woman presented with evanescent skin lesions and bilateral pleural effusions with an eosinophilic predominance. Following this case summary, a description of eosinophilic pleuritis, the epidemiology, etiologic considerations, and selected therapies for this syndrome are discussed. Eosinophilic pleural effusion is caused by myriad etiologies and is a therapeutic challenge.
Keywords: pleural effusion, eosinophilic effusion, dermatitis
25
Giebink, G. Scott, Margaret K. Hostetter, Barbara A. Carlson, Chap T. Le, Seth V. Hetherington et S. K. Juhn. « Bacterial and Polymorphonuclear Leukocyte Contribution to Middle Ear Inflammation in Chronic Otitis Media with Effusion ». Annals of Otology, Rhinology & ; Laryngology 94, no 4 (juillet 1985) : 398–402. http://dx.doi.org/10.1177/000348948509400414.
Texte intégralRésumé :
Bacteria can be cultured from approximately one third of chronic middle ear effusions, yet the contribution of these bacteria to the pathogenesis of chronic otitis media with effusion (OME) is not clear due to the absence of signs and symptoms of acute infection in most children with this disease. To explore the role of bacteria in chronic OME, lysozyme, lactoferrin, serum complement factors C3 and C5a, and polymorphonuclear leukocyte (PMNL) chemotaxin content was measured in 21 chronic middle ear effusion samples. Concentrations of lysozyme, lactoferrin, and chemotaxin were significantly higher in culture-positive than in sterile effusions. Lysozyme appeared to be contributed by both PMNL and non-PMNL sources in the middle ear space. These non-PMNL sources, presumably middle ear epithelial cells, accounted for 50% to 80% of the lysozyme variation in middle ear effusion. Although C3 and C5a were present in effusion, chemotaxin content correlated poorly with the C3 and C5a content, suggesting that chemotaxins were derived from bacterial peptides rather than from complement activation products. These results suggest that bacteria contribute to chronic middle ear inflammation with effusion. The eradication of bacteria from chronic middle ear effusion might disrupt the host responses which maintain chronic OME.
26
Majhi, Chakradhar, Butungeshwar Pradhan, Bikash C. Nanda et Sagnika Tripathy. « Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions ». International Journal of Advances in Medicine 5, no 3 (22 mai 2018) : 520. http://dx.doi.org/10.18203/2349-3933.ijam20181983.
Texte intégralRésumé :
Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other clinical and relevant biochemical tests were done to arrive in the final etiological diagnosis and data were collected and analysed .Pleural fluid cholesterol levels was correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion
27
Modi, Dipenkumar, Abhinav Deol, Divaya Bhutani, Lawrence G. Lum, Lois Ayash, Voravit Ratanatharathorn, Hyejeong Jang et al. « Incidence, Etiology and Outcome of Pleural Effusions in Patients Undergoing Allogeneic Stem Cell Transplantation ». Blood 126, no 23 (3 décembre 2015) : 5442. http://dx.doi.org/10.1182/blood.v126.23.5442.5442.
Texte intégralRésumé :
Abstract Introduction: Pleural effusions are common clinical finding in patients undergoing hematopoietic stem cell transplantation (HSCT). It can be a manifestation of underlying lung injury or a part of a systemic process. This study will investigate the incidence, risk factors, and clinical outcomes associated with pleural effusion in allogeneic HSCT. Methods: We conducted a retrospective study of 618 consecutive adult patients who underwent allogeneic HSCT for hematological disorders, between January 2008 and December 2013. Results: The baseline characteristics of the groups with and without pleural effusions are shown in table 1. The only significant difference was GVHD prophylaxis (p =0.002). A total 71 patients developed pleural effusions with the cumulative incidence of 12.6 % (95% CI, 10.0% to 15.6%) in five years. The median time of onset of pleural effusion from HSCT was 40 days (range, 1, 869). The onset of pleural effusion had a bimodal distribution with the first peak at 23 days (range 17, 29) and second peak at 362 days (range 277, 450). Based on chest CT criteria, the effusions were judged as large, moderate and small in size in 15%, 51% and 34% of patients respectively. Twenty five (35%) patients with pleural effusions underwent thoracentesis for respiratory difficulty and had a median of 800cc (range, 250 to 13500cc) of pleural fluid removed. Fourteen patients (56%) had exudative and 9 (36%) had transudative pleural effusions. Pleurx catheter was placed in 2 (3%), and chest tube in 3 (4%) patients. Causes of effusion listed in order of frequency are infection (38%), volume overload (23%), chronic GVHD (20%), heart failure (6%), engraftment syndrome (4%), veno-occlusive disease (4%), malignant pleural effusion (3%), hypersensitivity pneumonitis (1%) and iatrogenic (1%). Time of onset is different among various etiologies (p=0.006). Although thoracentesis was performed in 25 patients, the specific etiology by pleural fluid analysis was identified in only 2 patients. Pleural effusion secondary to infections, hypersensitivity pneumonitis, and engraftment syndrome occurred in the first 100 days after transplant, whereas pleural effusion due to chronic GVHD/polyserositis, bronchiolitis obliterans occurred 200 days after transplant.Fifty seven patients (80%) with pleural effusions had evidence of GVHD however; fourteen (20%) patients with pleural effusion had no evidence of acute or chronic GVHD. Twenty three (32%) patients had both pleural effusion and ascites, 27 (38%) had both pleural and pericardial effusion and 29 patients had pleural effusion alone. Multivariate cox regression analysis showed age, African American race, higher comorbidity index, unrelated donor, HLA-match 7/8, intermediate to high risk disease to be associated with worse survival among patients who developed pleural effusion after HSCT. There was no significant difference in overall survival between patients with or without pleural effusion (p=0.257). Conclusion: Majority of the patients who developed pleural effusions responded well with the treatment of the underlying disease. Although thoracentesis was often done for therapeutic reasons, it was a weak diagnostic tool. We did not identify any adverse impact of development of post HSCT pleural effusions on overall survival. Table 1. Characteristics Pleural Effusion (N=71) No Pleural Effusion (N=547) Signif Age - Median (range) year 55(25,73) 58(22,78) 0.514 Sex - no. (%) 0.522 Male/Female 43(61)/28(39) 305(56)/242(44) Diagnosis - no. (%) 0.490 AML 25(35) 213 (39) ALL 9(13) 53 (10) CLL 4(6) 27 (5) CML 2 (3) 16 (3) NHL 13 (18) 94 (17) Multiple Myeloma 3 (4) 16 (3) MDS 9 (13) 74 (14) Myelofibrosis 1 (1) 18 (3) Hodgkin's Lymphoma 1 (1) 8 (1) PLL 4 (6) 7 (1) Aplastic Anemia 0 (0) 17 (3) CMML 0 (0) 4 (1) Comorbidity-Median (range) 3 (0,8) 3 (0,9) 0.055 Disease risk status - no. (%) 0.389 Low 4 (6) 48 (9) Intermediate 32 (45) 284 (52) High 31 (44) 193 (35) Very High 4 (6) 22 (4) HLA - no. (%) 0.566 8/8 56 (79) 413 (76) 7/8 12 (17) 117 (21) <7/8 3 (4) 17 (3) Donor - no. (%) > 0.99 Matched related 25 (35) 197 (36) Matched unrelated 46 (65) 350 (64) Conditioning regimen - no. (%) 0.761 Full intensity 45 (63) 361 (66) Reduced intensity 26 (37) 186 (34) GVHD prophylaxis - no. (%) 0.002 Mycophenolate-Tacrolimus 41 (58) 328 (60) Mycophenolate-Tacrolimus-Thymoglobulin 26 (37) 131 (24) Tacrolimus- Thymoglobulin 3 (4) 17 (3) Thymoglobulin-Tacrolimus-Sirolimus 0 (0) 64 (12) Others 0 (0) 5 (1) Figure 1. Figure 1. Figure 2. Figure 2. Disclosures Deol: Bristol meyer squibb: Research Funding.
28
Gonlugur, Tanseli E., et Ugur Gonlugur. « Transudates in Malignancy : Still a Role for Pleural Fluid ». Annals of the Academy of Medicine, Singapore 37, no 9 (15 septembre 2008) : 760–63. http://dx.doi.org/10.47102/annals-acadmedsg.v37n9p760.
Texte intégralRésumé :
Introduction: The aims of this study were to determine the distribution of transudates and exudates among pathologically proven malignant pleural effusions, and to demonstrate the necessity for cytologic studies in patients with a transudative effusion. Materials and Methods: This study is a retrospective review of all subjects diagnosed with malignant or paramalignant pleural effusion over a 10-year period at a tertiary hospital. The study included 67 subjects with malignant mesothelioma, 45 subjects with metastatic disease, and 36 subjects with paramalignant effusions. Results: There were 55 female and 93 male subjects; the mean age of the sample was 62 years. Malignant pleural effusions were transudative in 1.5% of malignant mesotheliomas, 6.8% of metastatic diseases, and 11.1% of paramalignant effusions. Conclusions: Cytological examination of pleural fluid in patients with unexplained transudative effusion is essential to rule out malignant processes. Key words: Biochemical criteria, Pleural malignancy, Pleural neoplasms
29
Bediwy, Adel Salah, et Hesham Galal Amer. « Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies ». ISRN Pulmonology 2012 (31 janvier 2012) : 1–6. http://dx.doi.org/10.5402/2012/143295.
Texte intégralRésumé :
Background. Use of small-bore pigtail catheter is a less invasive way for draining pleural effusions than chest tube thoracostomy. Methods. Prospectively, we evaluated efficacy and safety of pigtail catheter (8.5–14 French) insertion in 51 cases of pleural effusion of various etiologies. Malignant effusion cases had pleurodesis done through the catheter. Results. Duration of drainage of pleural fluid was 3–14 days. Complications included pain (23 patients), pneumothorax (10 patients), catheter blockage (two patients), and infection (one patient). Overall success rate was 82.35% (85.71% for transudative, 83.33% for tuberculous, 81.81% for malignant, and 80% for parapneumonic effusion). Nine cases had procedure failure, five due to loculated effusions, and four due to rapid reaccumulation of fluid after catheter removal. Only two empyema cases (out of six) had a successful procedure. Conclusion. Pigtail catheter insertion is an effective and safe method of draining pleural fluid. We encourage its use for all cases of pleural effusion requiring chest drain except for empyema and other loculated effusions that yielded low success rate.
30
Nešković-Konstantinović, Z., S. Tasić, L. Vuletić, M. Branković, N. Ogrizović, Z. Nikolić, M. Vlajić et J. Josifovski. « CEA and CA 15-3 in Pleural Effusion of Advanced Breast Cancer Patients : Clinical Relevance and Diagnostic Value ». International Journal of Biological Markers 8, no 2 (avril 1993) : 94–102. http://dx.doi.org/10.1177/172460089300800205.
Texte intégralRésumé :
Serum and pleural effusion fluid were tested for CEA concentration in 83 advanced breast cancer patients, in 43 of whom CA 15-3 was also determined. All pleural effusions were clinically malignant. The sensitivity of the CEA test for the presence of pleural metastases was closer to that of the CA 15-3 test in effusion (0.59 and 0.79, respectively) than the sensitivity of CEA compared to CA 15-3 in serum (0.43 vs. 0.79). The use of two markers combined with cytology increased the diagnostic rate from 48% (cytologically positive) to 88% (cytologically positive and/or with one or both markers increased in effusion). A high diagnostic rate in cytologically negative effusions (65%), and in effusions presented as the sole metastatic involvement (100%), points to the clinical value of these two markers. Our results show that markers produced by pleural metastases may be secreted either into the effusion fluid or into serum, or both. This finding, as well as some other observations, are discussed in the present paper.
31
Srour, Nadim, Kayvan Amjadi, Alan John Forster et Shawn David Aaron. « Management of Malignant Pleural Effusions with Indwelling Pleural Catheters or Talc Pleurodesis ». Canadian Respiratory Journal 20, no 2 (2013) : 106–10. http://dx.doi.org/10.1155/2013/842768.
Texte intégralRésumé :
BACKGROUND: Management of malignant pleural effusion typically involves insertion of an indwelling pleural catheter (IPC) or chemical pleurodesis with agents such as talc.OBJECTIVES: To compare these management strategies with regard to success of pleural effusion management.METHODS: A retrospective cohort study was designed comparing patients with malignant and paramalignant pleural effusions and Eastern Cooperative Oncology Group performance status <4 managed with IPC insertion or talc pleurodesis (TP) through tube thoracostomy during non-contemporary three-year periods at a single centre.RESULTS: The IPC and TP groups comprised 193 and 167 patients, respectively. The pleural effusion control rate at six months was higher in the IPC group (52.7% versus 34.4% in the TP group; P<0.01), but the rate of freedom from catheter at 90 days and pleural effusion at 180 days was not significantly different (IPC 25.8% versus TP 34.4% [P=0.17]). Median effusion-free survival from the date of catheter insertion was significantly longer in the IPC group (101 days versus 58 days in the TP group; log-rank P=0.025). Both procedures were safe.DISCUSSION: While the results suggest better pleural effusion control and longer effusion-free survival with IPC insertion compared with TP, the present study had several limitations. Other recent studies have not shown one strategy to be clearly superior to the other.CONCLUSION: Both IPC insertion and TP remain acceptable options for the management of malignant pleural effusions.
32
Stevic, Ruza, Nikola Colic, Slavisa Bascarevic, Marko Kostic, Dejan Moskovljevic, Milan Savic et Maja Ercegovac. « Sonographic Indicators for Treatment Choice and Follow-Up in Patients with Pleural Effusion ». Canadian Respiratory Journal 2018 (30 octobre 2018) : 1–6. http://dx.doi.org/10.1155/2018/9761583.
Texte intégralRésumé :
Aim. The aim of this study was to evaluate the role of thoracic sonography in treatment of pleural effusions and to identify sonographic indicators for surgical intervention. Materials and Methods. This study included 378 patients with pleural effusions. US characteristics of effusions as the echo structure and pleural thickening were analyzed. Regarding the US finding, the diagnostic or therapeutic procedure was performed. Results. The study included 267 male and 111 female patients, an average of 56.7 years. Infection was the most frequent cause of effusion. Two hundred sixty-nine patients had loculated and 109 free pleural effusion. Most frequent echo structure of loculated effusion was complex septate, whereas free effusion was mostly anechoic. Successful obtaining of the pleural fluid without real-time guidance was in 88% and under real-time guidance in 99% patients (p<0.012). There was no significant difference in success rate between free and loculated effusion and regarding the echo structure (p=0.710 and 0.126, respectively). Complete fluid removal after serial thoracentesis or drainage was achieved in 86% patients. Forty-five patients with significantly thicker pleural peel and impairment of the diaphragmatic function than remaining of the group (p<0.001) underwent surgery. Open thoracotomy and decortication was more frequently performed in patients with completely fixed diaphragm and complex, dominantly septated effusions. There is no significant difference in US parameters comparing to patients underwent VATS, but the number of VATS is too small for valid conclusion. Conclusion. Thoracic sonography is a very useful tool in the evaluation of clinical course and treatment options in patients with pleural effusions of a different origin.
33
Khan, Bakht Umar, Fayaz Ahmed Memon, Muhammad Shehram, Muhammad Shahid, Fahad Khalid et Nayyar Arif. « Pericardial Effusionin Patients Admitted in Emergency Department : Frequency and Causes ». Pakistan Journal of Medical and Health Sciences 16, no 5 (30 mai 2022) : 1450–52. http://dx.doi.org/10.53350/pjmhs221651450.
Texte intégralRésumé :
Objective:A study of pericardial effusions in individuals with dyspnea was conducted to evaluate the prevalence and aetiology. Study Design:Prospective/Observational Study Place and Duration: Multicenteric study conducted at DHQ Hospital Bagh AJK/ Federal Govt. Polyclinic Hospital Islamabad and DHQ Teaching Hospital Gujranwala Medical College, Gujranwala. Duration was six months from 1st Oct 2021 to 31st March 2022. Methods:There were 135 patients of both genders had ages 18-75 years were presented in this study. Patients with dyspnea were admitted to emergency department. After obtaining informed written consent, we compiled detailed demographic information on all enrolled patients.Pericardial effusion was detected in all cases using echocardiography.The causes of pericardial effusion have been studied." SPSS 22.0 was used to analyze the data. Results: There were 75 (55.6%) males and 60 (44.4%) females in this study. Mean age of the patients was 58.16±10.79 years and had mean BMI 23.9±10.45 kg/m2. Majority of the patients were illiterate 90 (66.7%) and 45 (33.3%) were literate. We found frequency of pericardial effusions among 26 (19.3%) cases. Majority were males 17 (65.4%) and 9 (34.6%) were females. Most common cause of pericardial effusions were neoplastic diseases 10 (38.5%), idiopathic found in 8 (30.8%) cases, 3 (11.4%) had uremia, bacterial infections in 2 (7.7%) cases, frequency of HIV cases was 2 (7.7%) and 1 (3.8%) had other causes. Among 26 patients of pericardial effusions, small size effusion found in 14 (53.8%) cases, moderate size in 8 (30.8%) cases and large size in 4 (15.4%) cases. Conclusion: According to this study,patients with unexplained dyspnea had an increased risk of developing pericardial effusion,. The most prevalent cause of pericardial effusion was a neoplastic disease. Keywords:Electrocardiogram, Causes, Pericardial Effusion, Frequency, Dyspnea
34
Alam, Md Rafiqul, Md Nazmul Hasan, Md Abdur Rahim, Quazi Mamtaz Uddin Ahmed, Md Syedul Islam, Md Atikur Rahman et Md Rajibur Rahman. « Chylous Effusions (Pleural Effusion and Ascites) due to Non-Hodgkin’s Lymphoma A Case Report ». Bangladesh Medical Journal 47, no 2 (16 octobre 2019) : 38–40. http://dx.doi.org/10.3329/bmj.v47i2.43533.
Texte intégralRésumé :
Lymphoma can present with different type of serous effusion like pleural, pericardial and ascites and it signifies poor outcome .Pleural effusions are the most common type among these. Ascites and pericardial effusion are rare. Effusion can be can be caused by direct infiltration and impairment of the lymphatic drainage .Several investigations are available like study of the fluid for cytological, biochemical, immunohistochemistry and cytogenetics study to assess the qualities of effusion and make a quick diagnosis. This present case report will describe a case of 40 year old female patient with non-Hodgkin’s lymphoma (NHL) presented with generalized lymphadenopathy and chylous ascites and pleural effusion.
Bangladesh Med J. 2018 May; 47 (2): 38-40
35
Irfan, Muhammad, Abdul Rasheed Qureshi, Zeeshan Ashraf, Muhammad Amjad Ramzan, Tehmina Naeem et Huma Bilal. « Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard ? » Journal of Fatima Jinnah Medical University 13, no 4 (15 janvier 2020) : 184–90. http://dx.doi.org/10.37018/jfjmu.558.
Texte intégralRésumé :
ABSTRACT
Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.
Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis.
Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each.
Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.
36
Soong, Laura C., et Richard M. Haber. « Yellow Nail Syndrome Presenting With a Pericardial Effusion : A Case Report and Review of the Literature ». Journal of Cutaneous Medicine and Surgery 22, no 2 (25 octobre 2017) : 190–93. http://dx.doi.org/10.1177/1203475417738970.
Texte intégralRésumé :
Yellow nail syndrome (YNS) is a constellation of clinical findings including at least 2 of the 3 features of thickened yellow nails, respiratory tract involvement, and lymphedema. We report the case of a middle-aged man presenting with dystrophic, thickened yellow nails; an idiopathic pericardial effusion in the absence of pleural effusion(s); and unilateral apical bronchiectasis found on computed tomography of the chest. This represents a unique presentation of YNS as the first report of a patient with YNS and a pericardial effusion in the absence of pleural effusions and lymphedema and is the 11th case report of YNS with pericardial effusion.
37
ERAYMAN ÖZEN, Zeynep, M. Şule AKÇAY, Ali HARMAN et Özgür ÖZEN. « Characteristics of patients with transudative efusion followed in an university hospital ». Journal of Health Sciences and Medicine 5, no 5 (25 septembre 2022) : 1339–44. http://dx.doi.org/10.32322/jhsm.1132351.
Texte intégralRésumé :
Aim: To determine the etiological causes, radiological and laboratory features of transudative pleural effusions and to observe the clinical course after therapeutic thoracentesis. Material and Method: The files of patients with transudative effusion who underwent therapeutic thoracentesis by the Interventional Radiology Department between 01.01.2012 and 30.11.2012 were retrospectively reviewed. Pleural effusion (PE) anatomical features were evaluated with Postero anterior (PA) chest X-ray and Thorax Ultrasonography (USG). Demographic and clinical features, pleural effusion analysis results, presence and rates of complications were analyzed. Results: As a result of pleural fluid analysis, our study group consisted of 60 transudative pleural effusion cases, 36 (60%) women. The mean age was 71.23±2.36 years. Patients using diuretic therapy in cases with pleural effusion were statistically significantly higher than patients who did not (p<0.05). The most common etiologic causes were Congestive heart failure (CHF) and the accompanying disease hypertension (HT). Fifty (83.3%) of the pleural effusions were unilateral and 39 (65%) of them were right-sided (p<0.05). Diagnostic and therapeutic thoracentesis of our cases was performed by the radiologist under the guidance of thorax USG, and pneumothorax was observed in only one case (1.7%). In our 2-month clinical follow-up, the presence of recurrent pleural effusion was not detected in any of the cases. Conclusion: In cases with persistent transudative pleural effusion, therapeutic thoracentesis can be considered in cases where fluid resorption is not at the desired level despite effective treatment.
38
Satoh, Kasumi, Saori Morisawa, Manabu Okuyama et Hajime Nakae. « Severe pleural effusion associated with nilotinib for chronic myeloid leukaemia : cross-intolerance with tyrosine kinase inhibitors ». BMJ Case Reports 14, no 9 (septembre 2021) : e243671. http://dx.doi.org/10.1136/bcr-2021-243671.
Texte intégralRésumé :
Nilotinib is used as standard treatment in managing chronic myeloid leukaemia (CML). A 23-year-old man with CML and on nilotinib was admitted to the intensive care unit due to respiratory failure. Three years prior, he developed pleural effusion from dasatinib therapy thus, his CML regimen was changed to nilotinib. Although the pleural effusion had once improved, the chest imaging revealed left-dominant bilateral pleural effusion. Endotracheal intubation and left thoracic drainage were performed. Nilotinib treatment was discontinued, and approximately 60 hours later, nilotinib concentrations of 927 and 2092 ng/mL were determined in his blood and pleural effusion, respectively. Severe pleural effusion may be induced in patients administering nilotinib, and nilotinib concentrations in blood and pleural effusion can be elevated in patients with nilotinib-related pleural effusion. Cross-occurrence of pleural effusions needs to be monitored precisely, especially in patients who are switched to other tyrosine kinase inhibitors after dasatinib treatment.
39
Shidham, Vinod B. « Metastatic Carcinoma in Effusions ». Cytojournal 19 (31 janvier 2022) : 4. http://dx.doi.org/10.25259/cmas_02_09_2021.
Texte intégralRésumé :
Serous cavity may be involved by any neoplasm, including very rare examples of involvement by central nervous system tumors leading to a malignant effusion. The serous cavity lining is rich in lymphatics with lymphatic lacunae opening directly through narrow gaps (stoma) in the lining. Carcinomas mainly metastasize to serosa via the lymphatic vessels, which may be blocked leading to effusion. Primary carcinomas of organs such as lung, intestines, liver, ovary, etc., lined by serosal membranes may spread by direct extension, resulting in malignant effusions. As standard of practice, unless specified, cytopathologic examination of serous effusions implies detection of malignant cells. As compared to a surgical biopsy from a small focal area of an extensive serosal surface, effusion fluid from respective cavity exfoliates the cells from the entire serosal surface with minimal chance of sampling artifact. Because of this, effusion fluid cytology generally provides a higher diagnostic yield as compared to biopsy of the serous lining, as demonstrated by some studies. However, various challenges related to effusion fluid cytology makes the interpretation of effusion fluid cytology a field with potential misinterpretations, especially for those without proper experience or training. Developing and following a methodical approach is important for appropriate cytologic examination of effusion fluids. Proper approach may achieve definitive interpretation even without ancillary tests. However, lack of appropriate approach and processing may introduce a significant variation in interpretation due to combination of well-recognized diagnostic pitfalls, which may lead to lower reproducibility and even serious misinterpretations. Current review discusses in brief appropriate approach to processing and evaluating effusion fluid cytology for metastatic carcinoma. At general level, this is comparable to that of other specimens; however, it is critical to modify with reference to the limitations associated with effusion cytology.
40
G., Gomathi R., Sindhura Koganti, Dhanasekhar ., Chandrasekar . et Rajagopalan . « Role of bronchoscopy in pleural effusion bacterial infection ». International Journal of Advances in Medicine 7, no 3 (24 février 2020) : 523. http://dx.doi.org/10.18203/2349-3933.ijam20200670.
Texte intégralRésumé :
Background: In the present study was to investigate that the role of Bronchoscopy in pleural effusion in bacterial growth condition. Pleural effusion is one of the commonest problems with which patients present to the hospital. Pleural effusion is always abnormal and indicates the presence of an underlying disease. Despite the fact that there are many causes of pleural effusion, it is estimated that 90% of all pleural effusions are the result of only 5 disease processes: malignancy, pneumonia, pulmonary embolism viral infection, congestive heart failure.Methods: This is a Prospective and Observational Study. All patients diagnosed to have pleural effusion by x-ray, clinical examination and ultrasound examination of pleura if needed will undergo informed.Results: All 80 patients were included of whom 60(70%) were males and 20(30%) were females. Out of 80 patients, 5 patients are having bacterial growth (6.3%). All 5 patients who had exudative effusion, 4 were males and 1 female, 4 cases were right side effusion and 1 left sided effusion.Conclusions: Authors conclude that bronchoscopy has a definite role in the etiological diagnosis of pleural effusion in bacterial infection.
41
D'Souza, Melroy S., Kaitlin Shinn et Anup D. Patel. « Posttraumatic Subacute Effusive-Constrictive Pericarditis After a Motor Vehicle Accident ». Texas Heart Institute Journal 47, no 3 (1 juin 2020) : 233–35. http://dx.doi.org/10.14503/thij-19-7002.
Texte intégralRésumé :
Effusive-constrictive pericarditis is typically caused by tuberculosis or other severe inflammatory conditions that affect the pericardium. We report a case of effusive-constrictive pericarditis consequent to a motor vehicle accident. A 32-year-old man with gastroesophageal reflux disease presented with severe substernal chest pain of a month's duration and dyspnea on exertion for one week. Echocardiograms revealed a moderate pericardial effusion, and the diagnosis was subacute effusive-constrictive pericarditis. After thorough tests revealed nothing definitive, we learned that the patient had been in a motor vehicle accident weeks before symptom onset, which made blunt trauma the most likely cause of pericardial injury and effusion. Medical management resolved the effusion and improved his symptoms. To our knowledge, this is the first report of effusion from posttraumatic constrictive pericarditis associated with a motor vehicle accident. We encourage providers to consider recent trauma as a possible cause of otherwise idiopathic pericarditis.
42
Kennedy, C., C. McCarthy, S. Alken, J. McWilliams, R. k. Morgan, M. Denton, P. J. Conlon et C. Magee. « Pleuroperitoneal Leak Complicating Peritoneal Dialysis : A Case Series ». International Journal of Nephrology 2011 (2011) : 1–4. http://dx.doi.org/10.4061/2011/526753.
Texte intégralRésumé :
Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.
43
Bui, Peter V., Sonia N. Zaveri et J. Rush Pierce Jr. « Sanguineous Pericardial Effusion and Cardiac Tamponade in the Setting of Graves’ Disease : Report of a Case and Review of Previously Reported Cases ». Case Reports in Medicine 2016 (2016) : 1–6. http://dx.doi.org/10.1155/2016/9653412.
Texte intégralRésumé :
Introduction. Pericardial effusion in the setting of hyperthyroidism is rare. We present a patient with Graves’ disease who developed a sanguineous pericardial effusion and cardiac tamponade.Case Description. A 76-year-old man presenting with fatigue was diagnosed with Graves’ disease and treated with methimazole. Two months later, he was hospitalized for uncontrolled atrial fibrillation. Electrocardiography showed diffuse low voltage and atrial fibrillation with rapid ventricular rate. Chest radiograph revealed an enlarged cardiac silhouette and left-sided pleural effusion. Thyroid stimulating hormone was undetectable, and free thyroxine was elevated. Diltiazem and heparin were started, and methimazole was increased. Transthoracic echocardiography revealed a large pericardial effusion with cardiac tamponade physiology. Pericardiocentesis obtained 1,050 mL of sanguineous fluid. The patient progressed to thyroid storm, treated with propylthiouracil, potassium iodine, hydrocortisone, and cholestyramine. Cultures and cytology of the pericardial fluid were negative. Thyroid hormone markers progressively normalized, and he improved clinically and was discharged.Discussion. We found 10 previously reported cases of pericardial effusions in the setting of hyperthyroidism. Heparin use may have contributed to the sanguineous nature of our patient’s pericardial effusion, but other reported cases occurred without anticoagulation. Sanguineous and nonsanguineous pericardial effusions and cardiac tamponade may be due to hyperthyroidism.
44
Jiang, Rui, Martina Koch, Scott Gulbranson, Philip B. Komarnitsky, Eros Papademetriou et Jerzy Edward Tyczynski. « Predictors associated with development of pleural and pericardial effusions in patients with small cell lung cancer treated with third-line therapy. » Journal of Clinical Oncology 37, no 15_suppl (20 mai 2019) : e20088-e20088. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e20088.
Texte intégralRésumé :
e20088 Background: Pleural (Pl) and pericardial (Pc) effusions are often encountered clinical problems in patients with lung cancer, contributing to a poor quality of life. Population-based data on predictors for Pl and Pc effusions in small cell lung cancer (SCLC) are scarce, particularly, in later lines. Methods: We estimated the predictors for treatment-emergent Pl and Pc effusions in SCLC patients treated with third-line of therapy (LOT) using Optum’s electronic health records (EHR) de-identified database. Of 8,291 patients with newly diagnosed SCLC between 01/01/2008 and 09/30/2016, 428 patients received 3rd LOT. Pc/Pl effusions were identified by a combination of ICD-9/ICD-10 codes, procedures, or natural language processing (NLP) SDS term and sentiment. Each patient contributed to follow-up time from start of 3rd LOT to the day prior to start of next LOT or earlier of (loss to follow-up date or 365 days from end of 3rd LOT) if there was no subsequent LOT, or first occurrence for those with an outcome event. Stepwise Cox regression with sle = 0.25 and sls = 0.10 was applied for variable selection. Results: At start of 3rd LOT, median age was 65, 46% were male, 97% had extensive disease (excluding n = 53 with missing staging). Cardiac history, pulmonary history, renal impairment (eGFR < 60 mL/min/1.73m2), prior Pl and Pc effusion, albumin levels below 3.5 g/dl, sodium levels below < 136 mmol/l, treatment regimens (others except platin-containing vs. topotecan mono) was each associated with increased risk of Pl effusions. Cardiac history, prior Pl and Pc effusion, and region (South vs. Midwest/West) was each associated with increased risk of Pc effusions. When the stepwise Cox regression was applied, cardiac history, prior Pl effusion, and treatment regimens were selected as significant predictors of Pl effusions (p < 0.05). Prior Pc effusion and cardiac history were selected as significant predictors of Pc effusion (p < 0.05). Conclusions: Awareness of the determinants associated with development of Pl and Pc effusions in SCLC patients treated in third-line therapy may aid in earlier recognition of patients at risk and lower the risk of developing Pl/Pc effusions in this group of patients.
45
Stogova, N. A. « Bilateral pleural effusion : etiology, diagnostics ». PULMONOLOGIYA 32, no 6 (11 décembre 2022) : 885–90. http://dx.doi.org/10.18093/0869-0189-2022-32-6-885-890.
Texte intégralRésumé :
The problem of etiologic diagnosis of bilateral pleural effusions is important because of the relatively large number and variety of diseases accompanied by this syndrome, the complexity of diagnosis verification, and the frequent diagnostic errors. The aim of this review is to describe the spectrum of diseases causing bilateral pleural effusion and to consider a set of diagnostic measures to clarify the etiology of the process. Analysis of 60 literature sources showed that the most common causes of bilateral transudative pleural effusions are cardiac, hepatic, and renal insufficiency. Exudative bilateral pleural effusions are found in inflammatory processes in the pleura, including tuberculosis, and develop when inflammation is transmitted by contact or lymphohematogenous routes from the lungs or other organs. Bilateral localization of pleural effusion in tumor processes is observed in 5.7% of cases. Bilateral pleural effusion is seen in pulmonary embolism, diffuse connective tissue diseases, acute idiopathic pericarditis, postinfarction Dressler syndrome, after pericardotomy, and after pacemaker placement. It may be observed in such rare diseases as sarcoidosis, yellow nail syndrome, and Meigs syndrome, and may be induced by some drugs. Conclusion. The choice of therapeutic measures for bilateral pleural effusion is determined by an accurate etiological diagnosis of the underlying disease. The diagnosis should be based on the patient's clinical data and cytologic, microbiologic, and biochemical analysis of pleural fluid obtained by pleural puncture. In some cases, additional examination methods such as pleural biopsy, bronchoscopy, ultrasound, computed, magnetic resonance imaging of the chest and abdomen, and positron emission tomography are required.
46
Kaczmarek, Mariusz, Joanna Maciejewska, Łukasz Spychalski, Magdalena Socha-Kozłowska, Agata Nowicka et Jan Sikora. « Evaluation of Neutrophils Immunophenotype in the Microenvironment of Malignant Pleural Effusions ». Medical Journal of Cell Biology 6, no 2 (1 septembre 2018) : 66–74. http://dx.doi.org/10.2478/acb-2018-0012.
Texte intégralRésumé :
Abstract The lung cancer is often associated with the development of pleural effusion. Neutrophils are the most numerous population of immune system cells which are an essential component of tumor leukocyte infiltration. These cells are engaged in the development and maintenance of the inflammation. It is indicated that neutrophils support the development of cancer. The aim of the study was the evaluation of neutrophils, regarding their presence and activity in pleural effusions. This was achieved by assessing of molecular structures, which are used by neutrophils in chemotaxis and phagocytosis. 60 pleural effusions and 34 peripheral blood samples received from patients and 15 peripheral blood samples from the control group were analyzed. Expression of CD11a, CD11b, CD11c, CD18 and CD62L molecules with use flow cytometry was evaluated. The concentration of the neutrophil elastase in pleural effusions were measured with use ELISA test. The number of neutrophils in the peripheral blood of patients with pleural effusion was lower than that observed in the control group. Neutrophils present in pleural effusions were characterized by an increased ability to chemotaxis and secrete significant amounts of neutrophil elastase. Neutrophils recruited into the pleura during the formation of the effusion are an essential element of the developing inflammatory reaction in this environment. The presence of neutrophils in pleural effusion may promote its further formation and support the development of cancer.
47
Izhakian, Shimon, Walter G. Wasser, Benjamin D. Fox, Baruch Vainshelboim et Mordechai R. Kramer. « The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions ». Disease Markers 2016 (2016) : 1–6. http://dx.doi.org/10.1155/2016/7539780.
Texte intégralRésumé :
Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions.Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion.Results. The pleural CRP levels significantly differentiated the four groups (p<0.001) with the following means: parapneumonic effusion,5.38±4.85 mg/dL; lung transplant,2.77±2.66 mg/dL; malignancy,1.19±1.51 mg/dL; and heart failure,0.57±0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37–1.89).Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology.
48
Mamun, SM AA, et S. Sarker. « A case of bilateral recurrent exudative pleural effusion in a post COVID patient ». Bangladesh Journal of Medicine 32, no 2 (5 juin 2021) : 149–55. http://dx.doi.org/10.3329/bjm.v32i2.53801.
Texte intégralRésumé :
COVID-19-related pleural effusions are frequently described during the ongoing pandemic. Pleural effusions result from the accumulation of fluid in the pleural space surrounding the lungs. The most common causes of bilateral pleural effusions are due to congestive cardiac failure, nephrotic syndrome, anasarca due to any protein deficiency state or fluid overload, hypothyroidism. Few exudative causes of bilateral pleural effusion also like tuberculosis, primary and metastatic pleural malignancy, bronchogenic Ca, lymphomas, Immunological diseases: Mixed connective tissue disease, long standing cardiac failure or liver failure (on diuretics). Exudative causes of bilateral turbid pleural effusion with recurrent accumulation are very rare without any other associated pathology. The significance of pleural effusions in COVID-19 pneumonia has not been well assessed due to the rarity of the disease limited to case reports/series. A 72-year-old male patient comes to emergency with the complaints increasing shortness of breath for 3 days, Dry cough for same duration, H/O of COVID pneumonia 2 months back with no other comorbidity. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Pleural fluid study reveals exudative hemorrhagic turbid fluid with ADA 71.5 U/L with neutrophilicleukocytosis. Pleural fluid culture reveals moderate growth of pseudomonas species with scanty growth of Candida species. The patient was diagnosed as a case of bilateral complicated recurrent parapneumonic effusion and treated with antibiotic as culture sensitivity with steroids. After 4 times aspiration paracentesis patient was discharged with minimal bilateral pleural effusion. The patient has been followed for 4 months and now he is doing well.
Bangladesh J Medicine July 2021; 32(2) : 149-155
49
Walsh, Rowan F., et Devyani Chowdhury. « Incessant pericardial effusion in a 9 year old male responding to infliximab ». Cardiology in the Young 19, no 4 (août 2009) : 413–15. http://dx.doi.org/10.1017/s1047951109990229.
Texte intégralRésumé :
AbstractRecurrent idiopathic pericardial effusion can be a challenging medical problem. Multiple medical interventions may yield minimal improvement. We describe a patient with an incessant pericardial effusion that responded to infliximab. The use of infliximab should be considered in the management of recurrent pericardial effusions resistant to other treatment modalities.
50
GHAZI, MUHAMMAD A., et KHALID SAEED MALIK. « PRAMIPEXOLE INDUCED RECURRENT PLEURAL EFFUSION ». Professional Medical Journal 19, no 03 (10 mai 2012) : 418–21. http://dx.doi.org/10.29309/tpmj/2012.19.03.2139.
Texte intégralRésumé :
Context: Recurrent pleural effusions are relatively uncommon and as clinicians we keep drug induced pleural effusion lower inour list of differentials. Pramipexole induced recurrent pleural effusion can be life threatening if not recognized early and has been reported inliterature only a few times. Case Report: A 44 years old man with history of traumatic brain injury presented with pneumonitis and p leuraleffusion which was tapped. Patient returned with pleural effusion within 2 weeks and a careful analysis of all the risk factor and drugs revealedthat the most likely etiology was chronic use of Pramipexole leading to recurrent pleural effusion and early pulmonary fibrosis. Conclusions:Pramipexole induced recurrent pleural effusion can cause significant morbidity and should be recognized early. Physician prescribing thismedication should be aware of this rare side effect of the medication.