Accumulation Of Pleural Effusion Research Articles

PARTICULAR QUALITIES OF THE PROTEOLYTIC SYSTEM IN PATIENTS WITH TUBERCULOSIS DEPENDING ON THE SENSITIVITY OF THE PATHOGEN

The aim: Studying the features of the proteolytic system in patients with tuberculosis depending on the sensitivity of the pathogen. Materials and methods: In the course of the research we studied the level of elastase in the blood of 111 patients. The first group consisted of 66 (59.5%) people with pulmonary tuberculosis (39 were sensitive to antibacterial drugs, 27 were resistant). The second group included 13 (11.7%) patients with tuberculous pleurisy. The third group consisted of 32 (28.8%) patients with dual localization of the process (pulmonary tuberculosis and pleural tuberculosis). Results: The level of neutrophil elastase in patients with tuberculous pleurisy (253.2 nmol / min • ml) was 2.2 times higher than in patients with sensitive pulmonary tuberculosis (110.1 nmol / min • ml) and higher than in patients with resistant pulmonary tuberculosis 3.0 times. In combined pulmonary and pleural tuberculosis (third group) the level of elastase was 1.6 times higher than in pulmonary tuberculosis (176.9 nmol / min • ml)) (p <0.01), but lower than in pleurisy in 1, 4 times. In sensitive combined tuberculosis (lungs and pleura) the level of NE was 1.5 times higher than in patients of subgroup 1a (p <0.01) and 1.4 times lower than in patients with tuberculous pleurisy (p <0.01 ). Conclusions: The highest level of elastase in tuberculous pleurisy can be explained by its increased production, contributes to increased "permeability" of the pleural sheets and the accumulation of pleural effusion. In resistant forms of tuberculosis, the immune response in the form of the activity of the proteolytic system, which is lower than in sensitive forms, can be explained by the exhaustion of the immune system under the influence of aggressive tuberculosis. The above can be associated with both the weakening of the patient's body and the aggressiveness of the pathogen.

Establishment and characterization of Neu1-knockout zebrafish and its abnormal clinical phenotypes.

Mammalian sialidase Neu1 is involved in various physiological functions, including cell adhesion, differentiation, cancer metastasis, and diabetes through lysosomal catabolism and desialylation of glycoproteins at the plasma membrane. Various animal models have been established to further explore the functions of vertebrate Neu1. The present study focused on zebrafish (Danio rerio) belonging to Cypriniformes as an experimental animal model with neu1 gene deficiency. The results revealed that the zebrafish Neu1 desialyzed both α2-3 and α2-6 sialic acid linkages from oligosaccharides and glycoproteins at pH 4.5, and it is highly conserved with other fish species and mammalian Neu1. Furthermore, Neu1-knockout zebrafish (Neu1-KO) was established through CRISPR/Cas9 genome editing. Neu1-KO fish exhibited slight abnormal embryogenesis with the accumulation of pleural effusion; however, no embryonic lethality was observed. Although Neu1-KO fish were able to be maintained as homozygous, they showed smaller body length and weight than the wild-type (WT) fish, and muscle atrophy and curvature of the vertebra were observed in adult Neu1-KO fish (8 months). The expression patterns of myod and myog transcription factors regulating muscle differentiation varied between Neu1-KO and WT fish embryo. Expression of lysosomal-related genes, including ctsa, lamp1a, and tfeb were up-regulated in adult Neu1-KO muscle as compared with WT. Furthermore, the expression pattern of genes involved in bone remodeling (runx2a, runx2b, and mmp9) was decreased in Neu1-KO fish. These phenotypes were quite similar to those of Neu1-KO mice and human sialidosis patients, indicating the effectiveness of the established Neu1-KO zebrafish for the study of vertebrate Neu1 sialidase.

Multiplex Soluble Biomarker Analysis from Pleural Effusion.

Malignant pleural mesothelioma (MPM) is a highly aggressive and therapy resistant pleural malignancy that is caused by asbestos exposure. MPM is associated with poor prognosis and a short patient survival. The survival time is strongly influenced by the subtype of the tumor. Dyspnea and accumulation of pleural effusion in the pleural cavity are common symptoms of MPM. The diagnostic distinction from other malignancies and reactive conditions is done using histopathology or cytopathology, always supported by immunohistochemistry, and sometimes also by analyses of soluble biomarkers in effusion supernatant. We evaluated the soluble angiogenesis related molecules as possible prognostic and diagnostic biomarkers for MPM by Luminex multiplex assay. Pleural effusion from 42 patients with malignant pleural mesothelioma (MPM), 36 patients with adenocarcinoma (AD) and 40 benign (BE) effusions were analyzed for 10 different analytes that, in previous studies, were associated with angiogenesis, consisting of Angiopoietin-1, HGF, MMP-7, Osteopontin, TIMP-1, Galectin, Mesothelin, NRG1-b1, Syndecan-1 (SDC-1) and VEGF by a Human Premixed Multi-Analyte Luminex kit. We found that shed SDC-1 and MMP-7 levels were significantly lower, whereas Mesothelin and Galectin-1 levels were significantly higher in malignant mesothelioma effusions, compared to adenocarcinoma. Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1, NRG1-β1, VEGF and TIMP-1 were significantly higher in malignant pleural mesothelioma effusions compared to benign samples. Moreover, there is a negative correlation between Mesothelin and shed SDC-1 and positive correlation between VEGF, Angiopoietin-1 and shed SDC-1 level in the pleural effusion from malignant cases. Shed SDC-1 and VEGF have a prognostic value in malignant mesothelioma patients. Collectively, our data suggest that MMP-7, shed SDC-1, Mesothelin and Galectin-1 can be diagnostic and VEGF and SDC-1 prognostic markers in MPM patients. Additionally, Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1 and TIMP-1 can be diagnostic for malignant cases.

Antiphospholipid syndromeas a cause of chestpain and pleural effusion syndrome

According to the literature, antiphospholipid syndrome is a rare autoimmune disease that occurs in persons of both sexes. In its course, the syndrome has three types. Each of them has its own peculiarities, but for all of them typically are affection of the vessels of different types (arteries and veins) and diameter. In view of this, signs of angiopathy of different localization manifest the clinical picture. These can be peripheral and central disturbances. Affection of the vessels of the small circle of blood circulation may be accompanied by a clinic of thrombosis, where the main complaints are pain, stinging in to the pleural cavity, and short ness of breath. The «catastrophic» form of the disease ends with multiple organ failure. It is very difficult to bring out patients from this condition. It determines there relevance of the problem.Objective — share with the general medical community the experience of diagnosing and managing such patients.Materials and methods. Under our supervision were two patients who, after 36 weeks of gestation, had signs of a toxic syndrome.Results and discussion. In order to prevent the future development of complications was performed Caesarean section, but it was too late. Concerning the accumulation of pleural effusion, which led to respiratory failure, the pleural puncture was performed, which complicated the bleeding, which, at the background of multipleorgan failure, ending a lethal consequence.Conclusions. Manifestations of vascular in sufficiency should encourage the physician to think about the possibility of antiphospholipid syndrome with subsequent targeted follow-up, including the definition of antibodies to phospholipids. Dispensary observation of such patients should be performed by obstetrician gynecologists in cooperation with adjacent specialists, who may be involved in this syndrome: thoracic phthisiological surgeons, urologists, angiologists. The number of plate cells less than 50 000 ⋅ 109/l should be a contra indication to pleural puncture.

A case of minimal change nephrotic syndrome with immunoglobulin A nephropathy transitioned to focal segmental glomerulosclerosis

A 50-year-old woman with a 1-month history of lower extremity edema and a 5 kg weight increase was admitted to our hospital with suspected nephrotic syndrome in October 1999. Urine protein level was 3.5 g per day, 10-15 erythrocytes in urine per high-power field, and serum albumin level 2.5 g/dl. Furthermore, an accumulation of pleural effusion was confirmed by chest X-ray. The results of a renal biopsy indicated slight mesangial proliferation in the glomeruli by light microscopy, and an immunofluorescence study confirmed the deposition of immunoglobulin (Ig) A and C3 in the mesangial area. Diffuse attenuation of foot processes and dense deposits in the mesangial area were observed by electron microscopy. Treatment with 40 mg/day of prednisolone was effective, and proteinuria was negative 1 month later. Because of this course, we diagnosed minimal change nephrotic syndrome complicated by mild-proliferative IgA nephropathy. In November 2000, there was a relapse of nephrotic syndrome, which was believed to be induced by an influenza vaccination, but response to increased steroid treatment was favorable, and proteinuria disappeared on day 13 of steroid increase. A second relapse in May 2001, showed steroid resistance with renal insufficiency, and an increase in the selectivity index to 0.195. Light microscopy revealed focal sclerotic lesions of the glomeruli, and an immunofluorescence study revealed attenuation of mesangial IgA and C3 deposition. These findings led to the diagnosis that minimal change nephrotic syndrome had transitioned to focal segmental glomerulosclerosis, whereby mesangial IgA deposition was reduced by immunosuppressive treatment. Subsequently, her renal function gradually worsened to the point of end-stage renal failure by 27 months after the second relapse of nephrotic syndrome.

Incidental events of diaphragmatic surgery in 82 patients with advanced ovarian, primary peritoneal and fallopian tubal cancer

Surgical resections, such as peritoneal stripping (peritonectomy) are performed for disseminated diaphragmatic lesions of advanced ovarian cancer. This study retrospectively investigated the incidental events of diaphragmatic surgery. The records of patients with advanced mullerian carcinomas, including ovarian, primary peritoneal and fallopian carcinomas, who underwent diaphragmatic surgery were reviewed. Based on our criteria, stripping was performed for surface disease on the diaphragm, and full-thickness resection was performed for bulky disease. In certain cases, both procedures were performed. We analyzed intra- and post-operative incidental events in 82 patients. The χ(2) and Fisher's exact tests were used in the statistical analysis. There were 82 stage III-IV cases of which 56 patients underwent stripping, 12 underwent full-thickness resection and 14 patients underwent both procedures. Unexpected open chest surgery following stripping occurred in 1 out of 63 patients (1.6%) in the primary, 4 out of 13 patients (30.8%) in the interval and 0 out of 6 patients (0.0%) in the secondary debulking surgery groups. The incidence of unexpected open chest surgery was high in the interval debulking surgery group (p<0.001). Regarding post-operative events, accumulation of pleural effusion was identified in 43 patients (52.4%). The incidence of pleural effusions was not significantly different between the two procedures. No complications were encountered, nor was a chest tube required, during unexpected open chest surgery and postoperative pleural effusions. Therefore, it was concluded that special attention should be paid during interval debulking surgery even though it was possible for surgical resections of diaphragmatic lesions to be performed safely.

Real-Time Contrast-Enhanced Ultrasound – a New Simple Tool for Detection of Peritoneal-Pleural Communications in Hepatic Hydrothorax

Hepatic hydrothorax is defined as the accumulation of pleural effusion in a cirrhotic patient in the absence of pulmonary or cardiac disease. Peritoneal fluid can pass into the pleural space through diaphragmatic fenestrations. The demonstration of such passage is important to establish the diagnosis of hepatic hydrothorax and can be achieved by intraperitoneal injection of nuclear contrast agents. Our aim was to evaluate the ability of contrast enhanced ultrasound in the detection of peritoneal-pleural communications. Seven patients with cirrhotic ascites and pleural effusion were studied in order to make a diagnosis of hepatic hydrothorax. SonoVue was injected into the peritoneal cavity (9.8 mL), and the peritoneal and pleural cavities were monitored by ultrasound. All patients were then studied using a nuclear scan. Passage of SonoVue from the peritoneal to the pleural cavities was seen in 5 patients. In 2 patients, no passage of contrast agent was detectable. Nuclear scan was consistent with contrast enhanced ultrasound in all patients. This study shows that the presence of peritoneal-pleural communications can be demonstrated by real time contrast enhanced ultrasound, whose results are comparable to those of nuclear scan. Contrast enhanced ultrasound is cheaper and could theoretically be performed wherever ultrasound facilities are available.

再発した胸水貯留に対し五苓散が有効であった一症例

再発した胸水貯留に対し五苓散が有効であった一症例

Effects of Pleural Effusion on Respiratory Function

The accumulation of pleural effusion has important effects on respiratory system function. It changes the elastic equilibrium volumes of the lung and chest wall, resulting in a restrictive ventilatory effect, chest wall expansion and reduced efficiency of the inspiratory muscles. The magnitude of these alterations depends on the pleural fluid volume and the underlying disease of the respiratory system. The decrease in lung volume is associated with hypoxemia mainly due to an increase in right to left shunt. The drainage of pleural fluid results in an increase in lung volume that is considerably less than the amount of aspirated fluid, while hypoxemia is not readily reversible upon fluid aspiration.

Vascular endothelial growth factor correlates with matrix metalloproteinase-9 in the pleural effusion

Vascular endothelial growth factor (VEGF) is a potent, multifunctional cytokine that contributes to angiogenesis and inflammation. Matrix metalloproteinase-9 (MMP-9) is one of the major proteolytic enzymes that degrade various components of the extracellular matrix. Few data are available on the potential relationship between VEGF and MMP-9 in the accumulation of pleural effusion. We examined levels of VEGF and MMP-9 by means of enzyme immunoassay, zymographic analysis, and Western blot analysis in the patients with liver cirrhosis, tuberculosis, or lung cancer. The levels of VEGF and MMP-9 were significantly increased in the pleural fluids and sera of patients with tuberculosis and were even higher in patients with lung cancer compared with the patients with liver cirrhosis. A significant correlation was established between the level of VEGF and the level of MMP-9 in the pleural effusion. These results suggest that overproduction of VEGF and MMP-9 is associated with accumulation of the pleural effusion in tuberculosis and lung cancer. The relationship between VEGF and MMP-9 in the pleural effusion may have a role in the pathogenesis of pleural fluid formation.

High Level of Vascular Endothelial Growth Factor in Hemorrhagic Pleural Effusion of Cancer

Angiogenic cytokines, such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and angiogenin, are candidates for the induction of pleural effusions because they have been implicated in the induction of neovascularization, vascular permeability, and hemorrhage both in the inflammatory process and in tumor progression. Thus, we hypothesized that these angiogenic factors in effusion might be involved in the clinical manifestation of malignant pleural disease. We measured the levels of VEGF, bFGF, and angiogenin in pleural effusions and sera from 40 patients. Pleural effusions due to malignancy (1,350 pg/ml) contained significantly higher levels of VEGF than effusions due to inflammatory diseases (102 pg/ml; p = 0.034). Furthermore, hemorrhagic effusions showed significantly higher VEGF levels (1,942 pg/ml) than non-hemorrhagic effusions (202 pg/ml; p = 0.016) in malignant patients. In contrast, neither bFGF nor angiogenin were correlated with any clinical manifestation of pleural effusion. Immunohistochemical study revealed that malignant cells in the pleura were stained with anti-VEGF antibody. Our data suggest that VEGF secreted from tumor cells may be involved in the accumulation of pleural effusion in malignancy, and that increased levels of VEGF may induce hemorrhagic effusion.

Dyspnea resulting from accumulation of pleural effusion after radical neck dissection: A case report

The patient became dyspneic 3 days after radical neck dissection on the left side. A chest radiograph showed bilateral pleural effusion. During the operation, a lymphatic leak was noted. In this case, the factor of an associated perforation of the pleura had not been demonstrated. Fresh frozen plasma was administered and positive end-expiratory pressure was applied. The patient had no residual pulmonary sequelae.

1.心血行動態が胸部単純写真に及ぼす影響について(II.心疾患検査と放射線技術)

It occured to us that, to know the dynamics of blood circulation in the heart must be a prerequisite for taking chest plain radiograms of the patient under CCU at the optimum radiographing conditions. For verification we compared the chest plain radiograms and the results of examinations of the right heart catheterization by means of the Swan-Ganz catheter made on some 140 patients of acute myocardial infarction and of heart failure under CCU who were received by our hospital and got the following results : (1) In the case of the acute myocardial infarction patients, approximately 80% had P.W.P.s (pulmonary arterial wedge pressure) of 18 mmHg or lower. As to the case of heart failures, approximately 64.9% had P.W.P.s of 18 mmHg or higher. (2) For 19.5% of the patients of acute myocardial infarction and 68.2% of those of heart failure, pulmonary congestion was noticed. (3) A total of 71.7% of the patients of acute myocardial infarction had C.V.P.s (central venous pressure) of 10 mmHg or lower, and P.W.P.s 18 mmHg or lower. (4) For 4.3% of the patients of acute myocardial infarction, accumulation of pleural effusion was noticed. (5) In the case of heart failures, 8 among the 65 patients had vanishing tumors, which were noticed on the right thorax with effusion and cardiac index 2.2 l/min/m^2 or less in all the 8 cases. In the chest plain radiography under CCU it is important to take the above-listed phenomena into consideration. Radiographing conditions under which the radiograms were taken are useful for next opportunities and should be communicated to the succeeding radiographers.