• Title/Summary/Keyword: Pleural fluid

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Sugar Content and Protein Fractionation in Human Pleural Fluid (늑막액의 당 및 단백분획상)

  • Kim, W.J.;Ahn, Y.S.;Kim, H.Y.;Lee, W.Y.
    • The Korean Journal of Pharmacology
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    • v.15 no.1_2 s.25
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    • pp.1-5
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    • 1979
  • Previous studies concerning the usefulness of pleural fluid glucose levels in differentiating causes of pleural effusions have been conflicting. Gelenger and Wiggers (1949), Calnan et al(1951) and Barber et al(1957) concluded that the lower the level of pleural fluid glucose, the more likely was tuberculosis, and that tuberculosis was unlikely if the pleural fluid glucose level was more than 80 mg/100 ml. Light and Ball(1973), however, reported that in the great majority of tuberculous pleural fluids the glucose concentration was high rather than low, concluded that the pleural fluid glucose levels were not useful in the differential diagnosis of pleural effusion. In this study, pleural fluid glucose was determined in 46 pleural effusions from various causes to evaluate the usefulness in the differential diagnosis of pleural effusion. In addition, the protein concentration and the electrophoretic patterns of protein and amylases in pleural fluid was compared with that of serum. And the results were as follows. 1. The mean glucose concentration of pleural fluid was 80.8 mg/100 ml in 22 tuberculous origin, 92.5 mg/100 ml in 12 cancer patient and 70.4 mg/100 ml in 10 undiagnosed cases. In 2 cases of paragonimiasis the pleural fliud glucose levels were low (mean, 32.0 mg/100 ml). The percentage of pleural fluid protein to serum is about 75% in all disease groups and the protein level of tuberculous pleural fluid was significantly correlated with that of serum. 2. The disc eletrophoretic patterns of pleural fluid were almost similar with that of serum in all disease groups but the prealbumin fraction was not observed in pleural fluid. 3. With the isoelectric focusing, 4 to 7 isoamylase was observed in serum and the isoelectric point was ranged from pH 5.8 to 7.8 and isoelectic point of main fracticn is pH 7.2. The isoelectic focusing patterns of amylase of pleural fluid were identical to that of serum in all disease group. With the above results it is concluded that the pleural fluid is exudate of serum and that the glucose levels of pleural fluid are not useful in the differential diagnosis of pieural effusions.

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Clinical Utility of Two Interferon-gamma Release Assays on Pleural Fluid for the Diagnosis of Tuberculous Pleurisy

  • Kang, Ji Young;Rhee, Chin Kook;Kang, Na Hyun;Kim, Ju Sang;Yoon, Hyoung-Kyu;Song, Jeong Sup
    • Tuberculosis and Respiratory Diseases
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    • v.73 no.3
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    • pp.143-150
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    • 2012
  • Background: The release of interferon-gamma (IFN-${\gamma}$) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-${\gamma}$ release assays from pleural fluid for the diagnosis in tuberculous pleurisy. Methods: We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden. Results: Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-${\gamma}$ secreting T cells and the concentration of IFN-${\gamma}$ were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-${\gamma}$ producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood. Conclusion: These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-${\gamma}$ release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.

Pleural Fluid to Serum Cholinesterase Ratio for the Differential Diagnosis of Transudates and Exsudates (여출액과 삼출액의 감별진단을 위한 흉막액과 혈청에서의 Cholinesterase 비율의 진단적 의의)

  • Cho, Ho;Kim, Hyun-Il;Eum, Min-Sup;Kwon, Han-Jin;Oh, Yong-Leul;Kim, Kwang-Suk;Kim, Hui-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.5
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    • pp.781-787
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    • 2000
  • Background : The established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiating the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiating pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. Methods : A total of forty-three patients with known causes of the pleural of the pleural effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Ligt's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio, the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. Results : The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol 2.3% ; pleural fluid to serum cholesterol, ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum chlinesterase ratio, 2.3%. Conclusions : The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If fur1her studies confirm the results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and, if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.

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Significance of Pleural Fluid PCR and ADA Activity in the Diagnosis of Tuberculous Pleurisy (결핵성 늑막염의 진단시 늑막액의 Tb PCR 및 ADA활성도에 관한 연구)

  • 황재준;최영호;김욱진;신재승;손영상;김학제
    • Journal of Chest Surgery
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    • v.33 no.8
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    • pp.669-675
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    • 2000
  • Background: Tuberculous pleurisy is the leading cause of pleural effusion in Korea. And differential diagnosis of tuberculous pleurisy with other cause is clinically very important. Traditional diagnostic methods such as routine analysis of pleural fluid, staining for acid-fast bacilli or pleural biopsy have major inherent limitaion. This study was designed to evaluate the significance of pleural fluid polymerase chain reaction(PCR) and adenosine deaminase (ADA) activity in early diagnosis of tuberculous pleurisy. Material and Method: Between March 1996 and July 1997, 198 patients with pleural effusion reviewed retrospectively. The study group included 112 cases with tuberculous effusion and 86 cases with non-tuberculous effusions, whose diagnoses were confirmed by pleural biopsy, microbiological methods, or cytology. We compared the results of PCR and pleural fluid levels of ADA between tuberculous and non-tuberculous effusions. Result: Mean age was 47.54$\pm$19.52 years(range 2 to 85 years). The positive rate of PCR was significantly higher in tuberculous group than non-tuberculous group(p<0.05). The sensitivty, specificity, positive predictive value(PPV), and negative predictive value(NPV) for PCR were 31.7, 90.9, 83.0, and 48.8%, respectively. Mean ADA activity was significantly higher in tuberculous group than non-tuberculous group(83.2 U/L vs 49.8 U/L)(p<0.05). With diagnostic thresholds of 40 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 75.9, 70.9, 77.3, and 69.3% respectively. At a level of 70 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 70.1, 75.9, 82.9, and 60.3% respectively. Conclusion: PCR is very highly specific, but less sensitive methods in diagnosis of tuberculous pleurisy. But ADA level of pleural fluid has acceptable sensitivity and specificity in diagnosis of tuberculous pleurisy. ADA activity is more useful test in the evaluation of pleural effusions.

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Measurement of Nitric Oxide in the Differential Diagnosis of Lymphocytic Pleural Effusion (림프구성 흉막염의 감별 진단에서 NO(nitric oxide)의 측정)

  • Kim, Tae-Hyung;Sohn, Jang Won;Yoon, Ho Joo;Shin, Dong Ho;Park, Sung Soo
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.4
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    • pp.361-367
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    • 2005
  • Background : Differential diagnosis of lymphocytic pleural effusion is difficult even with many laboratory findings. Nitric oxide(NO) level is higher in the sputum or exhaled breath of patients with active pulmonary tuberculosis than in those without tuberculosis. In addition, there are some reports about the increased level of NO metabolites in body fluids of cancer patients. However, there is no data on the NO levels in the pleural fluid of patients with tuberculous pleurisy. Method : The serum and pleural fluid NO in the patients with acute lymphocytic pleural effusion were analyzed. Results : Of total 27 patients, there were 14 males and average age of patients was 48 years. The final diagnosis was tuberculous pleurisy in 17 cases and malignant pleural effusion in 10. The pleural fluid NO level was $540.1{\pm}116.4{\mu}mol$ in the tuberculous pleurisy patients and $383.7{\pm}71.0{\mu}mol$ in the malignant pleural effusion patients. The serum NO level was $624.7{\pm}142.0{\mu}mol$ in tuberculous pleurisy patients and $394.4{\pm}90.4{\mu}mol$ in malignant pleural effusion patients. There was no significant difference in the serum and pleural fluid NO level between the two groups. The NO level in the pleural fluid showed a significant correlations with the pleural fluid neutrophil count, the pleural fluid/serum protein ratio, and pleural fluid/serum albumin ratio (p<0.05 in each). The protein concentration, leukocyte and lymphocyte count in the pleural fluid were significantly higher in the tuberculous pleurisy patients than the malignant pleural effusion patients (p<0.05 in each). Conclusion : NO is not a suitable marker for a differential diagnosis of lymphocytic pleural effusion. However, the NO level in the pleural fluid might be associated with the neutrophil recruitment and protein leakage in the pleural space.

Comparision of Blood Gas Analyser, pH Meter and pH Strip Methods in the Measurement of Pleural Fluid pH (흉수의 pH 측정에서 혈액가스분석기계, pH meter, pH Strip 방법의 비교)

  • Jee, Hyun-Suk;Park, Yong-Bum;Choi, Jae-Chol;Ahn, Chang-Hyuk;Yoo, Ji-Hoon;Kim, Jae-Yeol;Park, In-Won;Choi, Byoung-Whui
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.5
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    • pp.773-780
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    • 2000
  • Background : pH measurement is an important test in assessing the etiology of pleurisy and in identifying complicated parapneumonic effusion. Although the blood gas analyzer is the gold standard method' for pleural pH measurement, pH meter & pH strip methods are also used for this purpose interchangably. However, the correlation among the pH data measured by the three different methods needs to be evaluated. In this study, we measured the pH of pleural fluid with the three different methods respectively and evaluated the correlation among the measured data. Methods : From August 1999 to March 2000, we measured the pleural fluid pH in 34 clinical samples with three methods-blood gas analyzer, pH meter, and pH strip. In the blood gas analyzer and pH meter methods, the temperature of pleural fluid was maintained around $0^{\circ}C$ in air-tight condition before analysis and measurement was performed within 30 minutes after collection. As for the pH strip method, the pleural fluid pH was checked in the ward immediately after tapping and in the clinical laboratory of our hospital. This part is unclear. Results : The causes of pleural effusion were tuberculosis pleurisy in 16 cases, malignant pleural effusion 5 cases, parapneumonic effusion 9 cases, empyema 3 cases, and congestive heart failure 1 case. The pH of pleural fluid (mean$\pm$SD) was 7.34$\pm$0.12 with blood gas analyser, 7.52$\pm$0.25 with pH meter, 7.37$\pm$0.16 with pH strip of immediate measurement and 6.93$\pm$0.201 with pH strip of delayed measurement. The pH measured by delayed pH strip measurement was lower than those of other methods (p<0.05). The correlation of the results between the blood gas analyzer and pH meter(p=0.002, r=0.518) and the blood gas analyzer and pH strip of immediate measurement(p<0.001, r=0.607). Conclusion : In the determination of pH of pleural fluid, pH strip method could be a simple and reliable method under immediate measurement conditions after pleural fluid tapping.

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Diagnostic Utility of Pleural Fluid Soluble Triggering Receptor Expressed on Myeloid Cells 1 Protein in Patients with Exudative Pleural Effusion (삼출성흉수에서 Soluble Triggering Receptor Expressed on Myeloid Cells 1 Proteion의 진단적 유용성)

  • Sim, Yun Su;Lee, Jin Hwa;Cheun, En Mi;Chang, Jung Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.62 no.6
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    • pp.499-505
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    • 2007
  • Background: Triggering receptor expressed on myeloid cells 1 protein (TREM-1) is a cell surface molecule expressed on neutrophils and monocytes, and it plays an important role in myeloid cell-activated inflammatory response. The aim of this study was to investigate the diagnostic efficiency of soluble (s) TREM-1 in the patients who had pleural effusion from various causes. Methods: Forty-five patients with exudative pleural effusion were included in this study. The level of sTREM-1 was measured in both the serum and pleural fluids by immunoblot assay with using human-sTREM-1 antibody. Results: The pleural fluid sTREM-1 was significantly different in the three groups of exudative pleural effusion (p=0.011). Particularly, the patients with parapneumonic effusion were found to have significantly higher pleural fluid levels of sTREM-1 than patients with tuberculous (p<0.05) and malignant effusion, respectively (p<0.05). However, the serum sTREM-1 did not show a significant difference in the three groups. In order to evaluate the diagnostic utility of pleural fluid sTREM-1, the receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) was 0.818 (p=0.001). Using a cutoff value of 103.5 pg/mL for the pleural fluid sTREM-1, the sensitivity and specificity were 73% and 81%, respectively, for differentiating parapneumonic effusion from tuberculous or malignant effusions. Conclusion: Pleural fluid sTREM-1 can be an additional marker for making the differential diagnosis of pleural effusion.

Cytologic Features of an Angiosarcoma in Pleural Fluid - A Case Report - (흉수의 혈관육종의 세포학적 소견 - 1예 보고 -)

  • Chu, Young-Chae;Park, In-Seo;Kim, Yoon-Ju;Han, Hye-Seung;Han, Jee-Young
    • The Korean Journal of Cytopathology
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    • v.10 no.1
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    • pp.61-66
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    • 1999
  • Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck legion. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread all space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or protected in spindly fashion. Almost ail tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.

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Pleural Space Elastance and Its Relation to Success Rates of Pleurodesis in Malignant Pleural Effusion

  • Masoud, Hossam Hosny;El-Zorkany, Mahmoud Mohamed;Ahmed, Azza Anwar;Assal, Hebatallah Hany
    • Tuberculosis and Respiratory Diseases
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    • v.84 no.1
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    • pp.67-73
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    • 2021
  • Background: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid. Methods: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with "PEL 0.5" (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes. Results: After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001). Conclusion: PEL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.

TNF-α in the Pleural Fluid for the Differential Diagnosis of Tuberculous and Malignant Effusion (결핵성 및 악성흉수의 감별에 있어 흉수 내 TNF-α의 유용성)

  • Kim, Hye Jin;Shin, Kyeong Cheol;Lee, Jae Woong;Kim, Kyu Jin;Hong, Yeong Hoon;Chung, Jin Hong;Lee, Kwan Ho
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.625-630
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    • 2005
  • Background : Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-${\alpha}$), which is the one of proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF-${\alpha}$ activity in distinguishing tuberculous from malignant effusions. Methods : 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF-${\alpha}$ concentrations were measured in the pleural fluid and serum samples using an enzyme-linked immunosorbent assay (ELISA). In addition, TNF-${\alpha}$ ratio (pleural fluid TNF-${\alpha}$ : serum TNF-${\alpha}$) was calculated. Results : TNF-${\alpha}$ concentration and TNF-${\alpha}$ ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p<0.05). However, the serum levels of TNF-${\alpha}$ in the malignant and tuberculous pleural effusions were similar (p>0.05). The cut off points for the pleural fluid TNF-${\alpha}$ level and TNF-${\alpha}$ ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF-${\alpha}$ level (p<0.005) and 76%, 70% and 0.72 for the TNF-${\alpha}$ ratio (p<0.05). Conclusion : We conclude that pleural fluid TNF-${\alpha}$ level and TNF-${\alpha}$ ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF-${\alpha}$ in the pleural fluid could be a more efficient marker than the TNF-${\alpha}$ ratio.