• Title/Summary/Keyword: Pleural fluid

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Treatment of Malignant Effusion with Intracavitary OK-432 Chemical Pleurodesis (악성흡수에 OK-432를 이용한 흉막유착술)

  • 김맹호;이헌재
    • Journal of Chest Surgery
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    • v.29 no.4
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    • pp.414-419
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    • 1996
  • To determine the efficacy of OK-432 as pleural sclerosant, we examined the outcomes in 81 patients (age : 27 to 82 years) with malignant pleural effusion and the outcomes in 64 patients ecieving OK-432 3-10KE(1 Klinische Einheit unit) through a chest tube for malignant pleural effusions. Of 81 patients with malignant pleural effusion, 40 patients had lung cancer. Lung cancer is the most frequent cause of malignant pleural effusion in men and women, in which 57 oyo of it was adenocarcinoma. Eighty seven percent of patient had respiratory symptom. Of the 64 patients with intracavitary injection of OK-432 for malignant pleural effusion, 59 patients had a complete short-term response (no fluid reaccumulation during 1 month after intracavitary injection of OK-432). Five patiens of the non-responders had partial control of effusion, with improvement in respiratory symptoms and these patients underwent thoracentesis. Of the 51 patients who survived longer than 1 month, 48 patients did not have re- accumulation of the fluid during follow up. Fever after intracavitary injection of OK-432 was a majors side effect although but that was easily controlled with non-steroidal anti inflammatory drug therapy, Thus the efficacy of intracavitary OK-4)2 injection for malignant pleural effusion was very helpful.

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The Utility of Pleural Fluid Cell IFN-γ Production Assay in the Diagnosis of Tuberculous Pleurisy (결핵성 흉막염의 진단에서 결핵균 항원 자극에 의한 흉수 세포의 IFN-γ 분비 검사의 유용성)

  • Park, Jae Seuk;Kim, Youn Seup;Jee, Young Koo;Lee, Kye Young;Choi, Jooyoung;Cho, Sungae;Cho, Sang-Nae
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.2
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    • pp.186-192
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    • 2005
  • Background : Diagnosis of tuberculous pleurisy is sometimes difficult using conventional diagnostic methods. We have investigated the utility of pleural fluid cell $IFN-{\gamma}$ production assay in the diagnosis of tuberculous pleurisy. Methods : We prospectively performed pleural fluid cell $IFN-{\gamma}$ production assay in 39 patients with tuberculous pleural effusions (TPE) and in 26 patients with nontuberculous pleural effusions (NTPE) (13 malignant pleural effusions and 13 parapneumonic effusions). Pleural fluid cells were cultured in DMEM media and stimulated with purified protein derivatives (PPD), and phytohemagglutinin (PHA) for 24 hr. The amount of $IFN-{\gamma}$ released in the culture supernatant was quantitated by $IFN-{\gamma}$ ELISA assay. We have also measured adenosine deaminase (ADA) activities and $IFN-{\gamma}$ concentrations in the pleural fluid. Results : 1) The pleural fluid levels of ADA activity and $IFN-{\gamma}$ concentrations were significantly higher in TPE than NTPE (p<0.01). 2) $IFN-{\gamma}$ production in TPE cells stimulated by PPD ($755,266{\pm}886,636pg/ml$) was significantly higher than NTPE cells ($3,509{\pm}6,980pg/ml$) (p<0.01). By considering the fact that $IFN-{\gamma}$ concentrations over 10,000 pg/ml is a criteria for the diagnosis of TBE, sensitivity and specificity of the test were 97.4 and 92.3%, respectively. 3) The ratios of $IFN-{\gamma}$ production by the stimulation with PPD and PHA (PPD/PHA) were significantly higher in TPE cells ($59{\pm}85$) than NTPE cells ($5{\pm}18$)(p<0.01). Considering the criteria for the diagnosis of TBE as PPD/PHA ratio over 5, sensitivity and specificity of the test were 76.9 and 92.3%, respectively. Conclusion : Pleural fluid cell $IFN-{\gamma}$ production assay may be useful for the diagnosis of tuberculous pleurisy.

Availability of Toluidine Blue Stain in Body Fluid (체액 검체에서 톨루이딘 블루 염색의 유용성)

  • Lee, Hye-Kyung;Joo, Myung-Jin;Lee, Kwang-Min;Lee, Eun-Hee;Sim, Sang-In
    • The Korean Journal of Cytopathology
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    • v.10 no.1
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    • pp.7-11
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    • 1999
  • We evaluated the availability of toluidine blue stain in body fluids, such as peritoneal and pleural fluid and urine. Nine hundreds specimens, i.e., 400 pleural and 400 peritoneal fluids and 100 urine samples, respectively, from Jan. 1995 to May 1996 were included. We obtained the result of high sensitivity and high specificity. In toluidine blue stained body fluid in comparison with Papanicolaou stained result. Additionally, we found the diagnostically important crystals in chylothorax and some urine samples, which can not be seen in routine Papanicolaou stain. We thought the toluidine blue stain in body fluid is one of very useful diagnostic methods.

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Subarachnoid-Pleural fistula after Excision of Posterior Mediastinal Mass (후종력동종양제거술후 발생한 척추지주막하늑막강루)

  • 신지승;최영호;김현구;조성준;김학제
    • Journal of Chest Surgery
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    • v.33 no.6
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    • pp.525-527
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    • 2000
  • Subarachnoid-pleural fistula after routine thoracotomy is a rare complication but a very serious problem. Twenty one cases have been reported in the literature. We report a care of subarchnoid-pleural fistula that dveloped after the esecation of posterior mediastinal neurogenic tumor. The patient presented with large amount of clear pleural fluid with mild headache and dizziness. Surgical intervention following a trial of conservative therapy was undertaken because we strongly suspected subarachnoid-pleural fistula. A dural tear was found at the level of resected intercostal nerve root. The dura was closed by way of direct suture and fibrin glue. In this case, the recognition of subarachnoid-pleural fistula formation is difficult because the patient had not presented any neurologic deficit.

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Diagnostic value of C-reactive Protein and Vascular Endothelial Growth Factor in Differentiation of Pleural Effusions (흉막액 감별에 있어서 C-반응성단백과 혈관내피성장인자의 유용성)

  • Kim, Sang Ha;Lee, Won Yeon;Park, Joo Young;Park, Hyun Sook;Han, Hye-Kyoung;Ju, Hun Su;Hong, Tae Won;Lee, Nak Won;Shin, Kye Chul;Yong, Suk Joong
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.5
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    • pp.467-477
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    • 2003
  • Background : Pleural effusions are generally divided into transudates and exudates. If it is exudative, more diagnostic tests are required in order to determine the cause of the local disease. A malignancy is a common and important cause of exudative pleural effusions. Because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions, several tumor markers have been examined. In order to overcome this limitation, this study hypothesized that C-reactive protein(CRP) and vascular endothelial growth factor(VEGF) measurements would be useful for differentiating trasudates from exudates and determining the differences between a benign and malignant effusion. Methods : Eighty consecutive patients with a pleural effusion (tuberculous 20, parapneumonic 20, malignant 20, transudative 20) were examined prospectively: 60 of them were classified according to Light's criteria as having an exudative fluid and 20 had a transudative fluid. The standard parameters of a pleural effusion were examined and the serum and pleural effusion VEGF levels were measured using enzyme linked immunosorbent assay(ELISA). CRP in the serum and pleural fluid was determined by a turbidimetric immunoassay. Results : The pleural CRP levels in the exudates were significantly higher than those in the transudates, $4.19{\pm}4.22mg/d{\ell}$ and $1.29{\pm}1.45mg/d{\ell}$, respectively. The VEGF levels in the pleural effusions were significantly elevated in the exudates compared to the transudate, $1,011{\pm}1,055pg/m{\ell}$ and $389{\pm}325pg/m{\ell}$, respectively. The VEGF ratio in the exudative effusion is significantly higher than a transudative effusions, $3.9{\pm}4.7$ and $1.6{\pm}0.9$, respectively. The pleural CRP levels in the patients with a benign effusion($4.15{\pm}4.20mg/d{\ell}$) were significantly higher than those in the malignant effusion($1.43{\pm}1.91mg/d{\ell}$). The VEGF ratio is significantly higher in malignant effusions($4.9{\pm}5.5$) than in benign effusions($2.8{\pm}3.6$). Conclusion : In conclusion, the CRP and VEGF levels in the serum and pleural effusion can distinguish between transudates and exudates. Moreover it can differentiate between benign and malignant pleural effusions.

Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion

  • Kim, Jeong-Eun;Lee, Chul;Park, Kook-In;Park, Min-Soo;NamGung, Ran;Park, In-Kyu
    • Clinical and Experimental Pediatrics
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    • v.55 no.5
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    • pp.177-180
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    • 2012
  • OK-432 (picibanil) is an inactivated preparation of $Streptococcus$ pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.

Soluble Interleukin-2 Receptor(sIL-2R) Levels in Patients Tuberculous Pleurisy VS Nontuberculous Pleurisy (결핵성 늑막삼출과 비결핵성 늑막삼출에서의 가용성 Interleukin-2 수용체의 농도)

  • Lim, Hyun-Oak;Ham, Jong-Yeol;Shim, Dae-Seok;Hwang, Young-Sil
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.2
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    • pp.135-143
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    • 1994
  • Background: The cell mediated immunity has an important role in the pathogenesis of tuberculosis. sIL-2R has been known as a sensitive marker of T lymphocyte activation Elevated serum levels of sIL-2R have been found in patients with lymphoproliferative disorders, organ transplantation, autoimmune diseases, and various granulomatous diseases. Elevated levels of sIL-2R have been also found in the serum and pleural fluid of the patients with tuberculosis. To evaluate the diagnostic value of sIL-2R in the differentiation of tuberculous pleurisy and nontuberculous pleurisy. We measured the level of sIL-2R in the sera and pleural fluids of 12 patients with tuberculous pleurisy and 32 patients with nontuberculous pleurisy. Method: Samples of pleural fluid and serum were centrifuged at 2500 rpm for 10 min to remove cell pellets. Soluble IL-2R was measured with a sandwitch enzyme immunoassay using the Cellfree(r) Interleukin-2 Receptor Test kit(T-cell science,Inc. Cambridge, MA). Results: The results obtained were as follows: 1) The sIL-2R level in pleural fluid of the patients with tuberculous pleurisy was higher than that of patients with nontuberculous pleurisy(P<0.005). 2) When the sIL-2R level above 5,000 u/ml in pleural fluid was used as the cut-off value to diagnose tuberculous pleurisy, it had a sensitivity of 84.6% and a specificity of 90.9%. 3) The sIL-2R level in the sera of the patients with tuberculous pleurisy was higher than that of patients with bacterial pleural effusions and normal control group(P<0.05) and there was no difference of levels compared with malignant pleural effusions and transudative pleural effusions(P>0.05). 4) In patients with tuberculous pleurisy, the mean concentration of sIL-2R in pleural fluid was higher than that in serum(P<0.005). Conclusion: These findings suggest that the measurement of elevated levels of pleural fluid sIL-2R in tuberculous pleurisy may be useful in the differential diagnosis between patients with tuberculous pleurisy and nontuberculous pleurisy.

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The effect of Postural Changes on Pleural Fluid Constituents (흉수 구성 성분의 체위에 따른 차이)

  • Park, Byung-Kyu;Lee, Hyo-Jin;Kim, Yun-Seong;Heo, Jeong;Yang, Yong-Seok;Seoung, Nak-Heon;Lee, Min-Ki;Park, Soon-Kew;Shin, Young-Kee;Han, Kyeong-Moon;Choi, Pil-Sun;Soon, Choon-Hee
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.2
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    • pp.221-227
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    • 1996
  • Background : Measurement of pleural fluid constituents are of value in the diagnosis of pleural effusions and in the seperation of exudates from transudates. The position of the patient(sitting or lying) prior to thoracentesis may result in difference in the measurement of these constituents. The purpose of this study is to determine whether postural differences in pleural fluid constituents exist, and if so, whether they are of any clinical significance. Method : 41 patients with pleural effusions on chest roentgenography were prospectively studied. The fluid cell counts, partial gas tension, and concentrations of chemical constituents were compared in the supine and upright positions. Results : 1) A total of 10 patients were found to have an transudative effusion. In the transudates there was no significant difference in pleural fluid constituents according to posture change. 2) A total of 31 patients were found to have an exudative effusion. Statistically significant postural changes were noted in pH, WBC counts, protein, and LDH concentrations in the exudates. It may be due to postural sedimentary effect in the pleural space. 3) The PCO2 measurements and glucose concentration were not affected by changes in position in exudates or transudates. Conclusion : Postural sedimentary effect occurs in the pleural space with reference to the measurement of certain pleural fluid constituents when an inflammatory process is present. Therefore it is recommended that thoracentesis after 30 minutes in the sitting position should be performed.

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A Case of Hepatic Hydrothorax (간수흉 1예)

  • Hong, In-Soo;Yang, Hak-Suk;Sung, Ki-Joon;Kim, Myung-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.26 no.2
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    • pp.392-395
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    • 1992
  • Hepatic hydrothorax is defined as the presence, in a cirrhotic patient, of a large pleural effusion in the absence of primary pulmonary or cardiac disease. Pleural effusions occur in 5% to 10% of patients with cirrhosis of the liver. The effusions are usually right-sided, but may be bilateral or left-sided. The precise mechanism of fluid accumulation is not clear. We reported a case of right hepatic hydrothorax occuring in the liver cirrhosis with ascites. Diagnosis was confirmed by the intraperitoneal and intrapleural injection of radioisotope $^{99m}Tc-tin$ colloid that demonstrated the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities.

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Diagnostic Value of Procalcitonin and C-Reactive Protein in Differentiation of Pleural Effusions (흉수의 감별에 있어서 procalcitonin과 C-반응성단백의 유용성)

  • Kim, Sang-Ha;Park, Joo Young;Park, Hyun Sook;Seo, Hee Seok;Kim, Shin Tae;Kim, Chong Whan;Lee, Bu Ghil;Lee, Seok Jeong;Lee, Shun Nyung;Noh, Jin Kyu;Lee, Min Su;Lee, Won Yeon;Yong, Suk Joong;Shin, Kye Chul
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.4
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    • pp.353-361
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    • 2007
  • Background: Malignancies are a common and important causes of exudative pleural effusions. Several tumor markers have been studied because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions. In an attempt to overcome this limitation, procalcitonin and C-reactive protein (CRP) in pleural effusions and serum, which are known to be inflammation markers, were measured to determine if they can differentiate an exudate from trasndate as well as the diverse causes of exudative pleural effusion. Methods: 178 consecutive patients with pleural effusion (malignant 57, tuberculous 51, parapneumonic 31, empyema 5, miscellaneous benign 7, transudative 27)were studied prospectively. The standard parameters of pleural effusion and measured serum and pleural procalcitonin were examined using in immunoluminometric assay. The level of CRP in serum and pleural fluid was determined by turbidimetric immunoassay. Results: The pleural procalcitonin levels in the exudate were significantly higher than those in the transudate, $0.81{\pm}3.09ng/mL$ and $0.12{\pm}0.12ng/mL$, respectively (p=0.007). The pleural CRP levels were significantly higher in the exudate than the transudate, $2.83{\pm}3.31mg/dL$ and $0.74{\pm}0.67mg/dL$, respectively (p<0.001). The pleural procalcitonin levels in the benign effusion were significantly higher than those in the malignant effusion, $1.15{\pm}3.82ng/mL$ and $0.25{\pm}0.92ng/mL$, respectively (p=0.032). The pleural CRP levels were significantly higher in the benign effusion than in the malignant effusion, $3.68{\pm}3.78mg/dL$ and $1.42{\pm}1.54mg/dL$, respectively (p<0.001). The pleural procalcitonin levels in the non-tuberculous effusion were significantly higher than those in the tuberculous effusion, $1.16{\pm}3.75ng/mL$ and $0.13{\pm}0.37ng/mL$, respectively (p=0.008). Conclusion: Measuring the level of procalcitonin and CRP in the pleural fluid is helpful for differentiating between transudates and exudates. In addition, it is useful for differentiating between benign and malignant pleural effusions.