Pleural Effusion Formation Research Articles

Challenges of Diagnosis and Management of Congenital Chylothorax in a Low-Resource Setting: A Case Report

Chylothorax is a form of pleural effusion. In the neonate, it may be diagnosed in the antenatal or postnatal period. Congenital forms of chylothorax are due to abnormal development or obstruction of the lymphatic system and may be associated with hydrops foetalis; it may also be idiopathic or associated with chromosomal anomalies. The diagnosis is usually based on biochemical analysis of pleural aspirate, and the interpretation of the biochemical parameters depends on whether the baby is feeding. The treatment involves dietary modification, the use of different types of drugs, chest tube drainage, pleurodesis or some other surgical intervention. There are no clinical trials to document the most effective treatment modality. Intrauterine interventions have been reported in some cases. We report a case of neonatal chylothorax to document the diagnostic challenges and management outcomes in a resource-limited setting.

Pulmonary Actinomycosis in a 65-Year-Old Female with Poor Oral Dentition.

Pulmonary actinomycosis is an uncommon clinical entity that can be challenging to diagnose due to its non-specific symptomatology. Misdiagnosis and delayed treatment may result in invasive procedures and extended antimicrobial treatment courses. We report a case involving a 65-year-old female with poor oral dentition admitted for acute respiratory failure subsequently found to have a left-sided pleural effusion and perihepatic abscess formation. Cytopathology examination and microbiology studies confirmed the diagnosis of pulmonary actinomycosis.

Pancreaticopleural Fistula: Navigating the Enigma of an Elusive Diagnosis

BACKGROUND: Pancreaticopleural Fistula is a Rare Complication of Acute and Chronic Pancreatitis. This Usually Presents With Chest Symptoms Due to Pleural Effusion, Pleural Pseudocyst, or Mediastinal Pseudocyst. Diagnosis Requires a High Index of Clinical Suspicion in Patients Who Develop Alcohol-induced Pancreatitis and Present With Pleural Effusion Which is Recurrent or Persistent. Analysis of Pleural Fluid for Raised Amylase Will Confirm the Diagnosis and Investigations Like Ct. The Rarity of Pancreaticopleural Fistulas, Especially Without the Context of Chronic Pancreatitis, Makes This Case Noteworthy. The Presence of Pleural Effusion in the Absence of Lung Disease Prompted Thorough Investigation, Leading to the Identification of an Unusual Etiology. THE CASE: A 35-year-old Alcoholic Male Presented to Emergency Room With 4-day History of Breathlessness Which Was Sudden Onset, Gradually Progressing to Grade-3 Dyspnea on NYHA Scale, Associated With Dry Cough. Hospitalization and Chest Radiograph1 Revealed Gross Right Side Pleural Effusion. Emergency thoracentesis and Intercostal Drainage Tube Placement were done and Patient Was Referred to Pulmonology Department. On further Evaluation, Patient Also Complained of Mild Persistent Left Upper Quadrant Abdominal Pain for More Than 6 Months Which Was Relieved on Medication Hence, Ignoring the Complaint. Thoracentesis Procedure Yielded 1.5l Amylase-rich Fluid in the Pleural Space. The Patient Was Then Referred to Surgical Department for Further Evaluation. Usg Abdomen Was Inconclusive. Lab Reports Revealed Mildly Elevated Pancreatic Enzymes. contrast- Enhanced Computed Tomography (Ct) Scan of the Abdomen and Chest Revealed a Dilated Main Pancreatic Duct and Multiple Direct Communication Between the Pancreatic Duct(see Figures 1) and the Right Pleural Space, Leading to the Formation of Massive Pleural Effusion and Complete Collapse of Right Lung. Rest of the Pancreas Appeared Normal With No Evidence of Calcification. After a Thorough Clinical Evaluation, Laboratory Investigations, and Imaging Studies, the Patient Was Diagnosed With a Pancreaticopleural Fistula. The Patient Was Managed Through a Multidisciplinary Approach Involving Gastroenterology, radiology, and General Surgery Teams. Initial Management Included Aggressive Medical Treatment With Bowel Rest, Total Parenteral Nutrition, Antibiotics and Administration of Proton Pump Inhibitors. The Patient Showed Gradual Improvement Post-drainage, With a Significant Decrease in Pleural Effusion Volume and Resolution of Dyspnea. Follow-up With CT scan Was Advised. The patient Was Subsequently Monitored Continuously With Dietary Recommendations. CONCLUSION: the Chosen Case is Significant Due to Its Diagnostic Intricacies and the Necessity for Collaboration Among Various Medical Specialties. The Management of Pancreaticopleural Fistulas Requires a Tailored Approach. This Case Underscores the Importance of Early Diagnosis, Meticulous Evaluation, and Timely Intervention in Achieving Successful Outcomes for Patients. In conclusion,by Sharing This Case, I Aim to Contribute to the Understanding of This Rare Condition and Emphasize the Significance of Timely Diagnosis and Appropriate Management Strategies.

C5a enhances inflammation and chemotaxis of γδ T cells in malignant pleural effusion

BackgroundThe inhibitory effect of γδT17 cells on the formation of murine malignant pleural effusions (MPE) has been established. However, there is limited understanding regarding the phenotypic characterization of γδ T cells in MPE patients and their recruitment to the pleural cavity. MethodsWe quantified γδ T cell prevalence in pleural effusions and corresponding peripheral blood from malignant and benign patients using immunohistochemistry and flow cytometry. The expression of effector memory phenotype, stimulatory/inhibitory/chemokine receptors and cytokines on γδ T cells in MPE was analyzed using multicolor flow cytometry. The infiltration of γδ T cells in MPE was assessed through immunofluorescence, ELISA, flow cytometry and transwell migration assay. ResultsWe observed a significant infiltration of γδ T cells in MPE, surpassing the levels found in blood and benign pleural effusion. γδ T cells in MPE exhibited heightened expression of CD56 and an effector memory phenotype, while displaying lower levels of PD-1. Furthermore, γδ T cells in MPE showed higher levels of cytokines (IFN-γ, IL-17A and IL-22) and chemokine receptors (CCR2, CCR5 and CCR6). CCR2 expression was notably higher in the Vδ2 subtype compared to Vδ1 cells. Moreover, the complement C5a enhanced cytokine release by γδ T cells, upregulated CCR2 expression in Vδ2 subsets, and stimulated the production of chemokines (CCL2, CCL7 and CCL20) in MPE. In vitro utilizing CCR2 neutralising and C5aR antagonist significantly reduced the recruitment of γδ T cells. Conclusionsγδ T cells infiltrate MPE by overexpressing CCR2 and exhibit hightened inflammation, which is further augmented by C5a.

S100A9 Regulated M1/M2 Macrophage Polarization in Interleukin-10-Induced Promotion of Malignant Pleural Effusion.

Interleukin-10 (IL-10) promotes the formation and development of malignant pleural effusion (MPE). Previous studies have elucidated the pathogenesis from the view of the immune-regulation function of CD4+ T-cells. However, the underlying mechanism is still not fully understood. In this study, our results showed that IL-10 deficiency reduced the percentage of macrophages in mouse MPE and regulated M1/M2 polarization in vivo and in vitro. The migration capacity of tumor cells was suppressed, and apoptosis was promoted when tumor cells were cocultured with MPE macrophages in the absence of IL-10. Messenger RNA sequencing of MPE macrophages showed that S100A9 was downregulated in IL-10-/- mice. Bone marrow-derived macrophages obtained from wild-type mice transfected with S100A9-specific small interfering RNAs (siRNAs) also showed less M2 and more M1 polarization than those from the siRNA control group. Furthermore, downregulation of S100A9 using S100A9-specific siRNA suppressed MPE development, decreased macrophages, and modulated macrophage polarization in MPE in vivo. In conclusion, S100A9 plays a vital role in the process of IL-10 deficiency-mediated MPE suppression by regulating M1/M2 polarization, thus influencing the tumor-migration capacity and apoptosis. This could result in clinically applicable strategies to inhibit the formation of MPE by regulating the polarization of MPE macrophages.

Exosomal miRNA-profiling of pleural effusion in lung adenocarcinoma and tuberculosis.

Pleural effusion (PE) caused by lung cancer is prevalent, and it is difficult to differentiate it from PE caused by tuberculosis. Exosome-based liquid biopsy offers a non-invasive technique to diagnose benign and malignant PE. Exosomal miRNAs are potential diagnostic markers and play an essential role in signal transduction and biological processes in tumor development. We hypothesized that exosomal miRNA expression profiles in PE would contribute to identifying its diagnostic markers and elucidating the molecular basis of PE formation in lung cancer. The exosomes from PE caused by lung adenocarcinoma (LUAD) and pulmonary tuberculosis were isolated and verified by transmission electron microscopy. The exosomal miRNA profiles were identified using deep sequencing and validated with quantitative real-time PCR (qRT-PCR). We performed bioinformatic analysis for differentially expressed miRNAs to explore how exosomal miRNAs regulate pleural effusion. We identified 99 upregulated and 91 downregulated miRNAs in malignant pleural effusion (MPE) compared to tuberculous pleural effusion (TPE). Seven differentially expressed miRNAs (DEmiRNAs) were validated by qRT-PCR, out of which 5 (71.4%) were confirmed through sequencing. Gene Ontology (GO) analysis revealed that most exosomal miRNAs target genes were involved in regulating cellular processes and nitrogen compound metabolism. According to the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, the exosomal miRNAs target genes were mainly involved in Fc gamma R-mediated phagocytosis, Rap1 signaling pathway, and breast cancer. The hub genes, including ITGAM, FOXO1, MAPK14, YWHAB, GRIN1, and PRF1, were screened through plug-in cytoHubba. The PFR1 was identified as a critical gene in MPE formation using single-cell sequencing analysis. Additionally, we hypothesized that tumor cells affected natural killer cells and promoted the generation of PE in LUAD via the exosomal hsa-miR-3120-5p-PRF1 axis. We identified exosomal miRNA profiles in LUAD-MPE and TPE, which may help in the differential diagnosis of MPE and TPE. Bioinformatic analysis revealed that these miRNAs might affect PE generation through tumor immune response in LUAD. Our results provided a new theoretical basis for understanding the function of exosomal miRNAs in LUAD-MPE.

Efficacy and safety of endostar combined with cisplatin in treatment of non-small cell lung cancer with malignant pleural effusion: A meta-analysis

Although there are new treatments for non-small cell lung cancer with malignant pleural effusion, these therapies are prone to recurrent pleural effusion and poor in efficacy. And recombinant human endostatin is a new type of anti-tumor angiogenesis drug independently developed in my country. It has the effect of inhibiting tumor angiogenesis, inhibiting tumor proliferation and differentiation, and effectively inhibiting the formation and recurrence of malignant pleural effusion. Therefore, this study is aim to systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in the treatment of non-small cell lung cancer (NSCLC) with malignant pleural effusion. Databases including Cochrane Library, PubMed, CBM, Embase, CNKI, and WanFang Data were searched to collect randomized controlled trials about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to April 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Finally, the meta-analysis was made by using RevMan 5.4.1 software. A total of 11 randomized controlled trials involving 814 patients were finally included. The results of the meta-analysis showed that: The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group (relative risk = 1.58, 95% confidence interval = 1.42-1.76, P < .00001; relative risk = 1.63, 95% confidence interval = 1.38-1.93, P < .00001, respectively). Meanwhile, there were no significant differences between the 2 groups in the incidence of gastrointestinal reaction, the incidence of leucopenia, the incidence of thrombocytopenia, and the incidence of hypodynamia (all P values > .05). Compared with cisplatin, intrapleural injection of endostar combined with cisplatin could improve the overall response rate and the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.

Pinealectomy and melatonin administration in rats: their effects on pulmonary edema induced by α-naphthylthiourea

We aimed to observe the possible effects of melatonin (MLT) deprivation (pinealectomy) and exogenous MLT administration on pulmonary edema induced by alpha-naphthylthiourea (ANTU), a toxic chemical agent, in rats. Seventy animals were assigned to seven groups: control, sham pinealectomy (PINX), PINX, ANTU (10 mg/kg intraperitoneal on day 30), ANTU + MLT (10 mg/kg/day i.p. for 30 days), ANTU + PINX, and ANTU + PINX + MLT. In this study, pleural effusion (PE) formation, lung weight/body weight (LW/BW) and PE/BW ratios (fluid accumulation and weight values in the lungs) increase detected. Pre-ANTU MLT administration led to significant decreases in PE, LW/BW, and PE/BW levels. The inhibited glutathione (GSH) and superoxide dismutase (SOD) levels and high malondialdehyde (MDA) levels that ANTU increase lipid peroxidation in the study. MLT administration eliminated oxidative stress by reducing MDA and ameliorating GSH and SOD levels. Pre-ANTU MLT administration led to a significant decrease in interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels in the lung when compared to the ANTU group without MLT administration. Post-pinealectomy ANTU administration significantly increased IL-1β and TNF-α levels when compared to ANTU and MLT administration without pinealectomy. Diffused inflammatory cell infiltration, interstitial pulmonary edema, and histopathological congestion were observed after the administration of ANTU. Severity of the damage was elevated in the ANTU + PINX group. MLT treatment regressed pulmonary effusion and edema and improves lung structure. In brief, the findings suggested that MLT inhibited proinflammatory mediators and could serve as a therapeutic agent to prevent inflammatory disorders.

Profile of Dengue Fever Complication in Infant at Tertiary Referral Hospital in East Java, Indonesia

Introduction: Dengue virus infection is caused by the dengue virus and transmitted through the bites of infected Aedes aegypti or Aedes albopictus mosquitoes. The spectrum of clinical manifestations is varied from asymptomatic, undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome, to expanded dengue syndrome. Data from 2016 in Indonesia revealed that dengue virus infection is common in the population, with a total of 333.821 cases of dengue hemorrhagic fever. Methods: This was a descriptive study with a cross-sectional design. The subjects in this study were children under 1-year-old, diagnosed with dengue virus infection, and had a complication. The number of subjects used is 60 infants. Results: Infection of dengue virus in infants is often found in the 7-9 month age group (36,6%). Clinical manifestations found were fever (100%), vomiting (62%), diarrhea (43%), petechiae (22%), bleeding (12%), and irritable (5%). Thrombocytopenia and leukopenia were found in 93,3% and 26,6% of infants respectively. Complications were found in the form of pleural effusion (66%), hypoalbuminemia (62%), hyponatremia (51%), liver involvement (49%), hypocalcemia (43%), hypokalemia (23%), bleeding (21%), brain involvement (21%), kidney involvement (13%), and ascites (11%).Conclusion: The most common clinical manifestations are fever, diarrhea, and vomiting, while the most common complications are pleural effusion, hypoalbuminemia, hyponatremia, liver involvement, and hypocalcemia.

Cardiopulmonary ultrasound correlates of pleural effusions in patients with congestive heart failure

BackgroundPleural effusions are common in patients with congestive heart failure. However, there is a need to assess systematically the correlation between effusion volume, extravascular lung water and echocardiographic parameters. We used combined cardiopulmonary ultrasound to evaluate the relationship between effusion volume, extravascular lung water, and echocardiographic parameters in patients with congestive heart failure.MethodsPatients who were hospitalized for congestive heart failure underwent combined cardiopulmonary ultrasound. A semiquantitative score of pleural effusions was derived by pulmonary ultrasound and extravascular lung water was estimated by ultrasound lung comets. The measurements were compared with echocardiographic and clinical results.ResultsAmong 168 patients (median age 66 years, 69.6% men), 102 (60.7%) had pleural effusions, 84.3% bilateral, 10.8% right-sided, and 4.9% left-sided. High pleural effusion scores were associated with high ultrasound lung comet scores (P < 0.0001). Compared with patients without pleural effusions, patients with pleural effusions were significantly older and had higher systolic pulmonary artery pressure (SPAP), NT-proBNP, New York Heart Association scale, larger left atrium, larger right ventricle, more severe mitral regurgitation, and worse left and right heart function. Adjusted for age, multiple logistic regression analysis showed that SPAP (OR 5.688, P = 0.006) and E/A (OR 3.941, P = 0.043) were the significant variables and risk factors associated with pleural effusions in heart failure.ConclusionFor patients with left heart failure, the degree of pleural effusions was associated with pulmonary congestion. Elevated SPAP and E/A were the main risk factors for the formation of pleural effusions in patients with congestive heart failure.

Incidence, clinical associations and outcomes of intrathoracic complications with and without ARDS in COVID-19 pneumonia

PurposeTo determine the incidence and clinical predictors of intrathoracic complications in COVID-19 patients, and the association with outcomes. MethodsIn this retrospective cross-sectional study, we included 976 patients (age 61 ± 17 years, 62% male) who tested positive for SARS-CoV-2 between March 3–April 4, 2020 and underwent chest imaging. 3836 radiographs from 976 patients and 105 CTs from 88 patients were reviewed for intrathoracic complications, including pneumothorax, pneumomediastinum, pneumopericardium, lobar collapse, pleural effusion, and pneumatocele formation. ResultsThere was a high rate of intrathoracic complications (197/976, 20%). Pleural effusion was the most common complication (168/976, 17%). Pneumothorax (30/976, 3%) and pneumatoceles (9/88, 10%) were also frequent. History of hypertension and high initial CXR severity score were independent risk factors for complications. Patients with any intrathoracic complication during admission had an over 11-fold risk of ICU admission (adjusted odds ratio [aOR] 11.2, p < 0.0001) and intubation (aOR 12.4, p < 0.0001), over 50% reduction in successful extubation (aOR 0.49, p = 0.02) and longer length of stay (median 13 versus 5 days, p < 0.0001). There was no difference in overall survival between patients with and without any complication (log-rank p = 0.94). ConclusionIn COVID-19 patients who underwent chest imaging, 1 in 5 patients have an intrathoracic complication, which are associated with higher level of care and prolonged hospital stay. Hypertension history and high CXR severity score confer an increased risk of complication. SummaryIntrathoracic complications in COVID-19 are common and are predictive of ICU admission, need for intubation, less successful extubation, and longer length of stay but are not predictive of mortality.

A Study on Prognostic Indicators of Severe Dengue Fever in Children

Dengue is the most important emerging tropical viral disease of humans and leading cause of death in SEAR after diarrhea and acute respiratory infections. It is a significant public health concern with its geographical distribution becoming worldwide, involving nearly all the tropical and subtropical regions of the world with significant morbidity and mortality. This study mainly aims at finding out the factors which were associated with severe dengue fever that helps determining the prognosis in children. This case control study was done during November 2017 to October 2018 from the children admitted in Pediatric ward, Vijayanagar institute of medical sciences, Ballari. Among the 201 study subjects, the factors like presence of bleeding manifestations(p˂0.001), low pulse pressue˂20 mmhg(p˂0.001), prolonged capillary refill time(p&lt;0.001), low O2 saturation(p&lt;0.001), Hyponatremia(p=0.008), elevated SGOT/SGPT levels(p&lt;0.001), Prolonged PT/APTT/INR levels(p&lt;0.001), respiratory and abdominal involvement in the form of pleural effusion, pneumonia and ascites(p&lt;0.001) were significantly associated with severe dengue fever with mortality of 15%. Leucopenia, thrombocytopenia and raising hematocrit was not found to have significant association with the severity of dengue fever in this study. These parameters may be used to predict, to forecast disease severity in patients suspected of dengue infection and to manage it early in the course of the illness. Various measures for early diagnosis and prompt intervention with emphasis on the warning signs and good supportive care would help decrease the fatality and morbidity associated with Dengue.

Higher CD4/CD8 ratio of pleural effusion predicts better survival for lung cancer patients receiving immune checkpoint inhibitors

Pleural effusion is a rare immune-related adverse event for lung cancer patients receiving immune checkpoint inhibitors (ICIs). We enrolled 281 lung cancer patients treated with ICIs and 17 were analyzed. We categorized the formation of pleural effusion into 3 patterns: type 1, rapid and massive; type 2, slow and indolent; and type 3, with disease progression. CD4/CD8 ratio of 1.93 was selected as the cutoff threshold to predict survival. Most patients of types 1 and 2 effusions possessed pleural effusion with CD4/CD8 ratios ≥ 1.93. The median OS time in type 1, 2, and 3 patients were not reached, 24.8, and 2.6 months, respectively. The median PFS time in type 1, 2, and 3 patients were 35.5, 30.2, and 1.4 months, respectively. The median OS for the group with pleural effusion CD4/CD8 ≥ 1.93 and < 1.93 were not reached and 2.6 months. The median PFS of those with pleural effusion CD4/CD8 ≥ 1.93 and < 1.93 were 18.4 and 1.2 months. In conclusion, patients with type 1 and 2 effusion patterns had better survival than those with type 3. Type 1 might be interpreted as pseudoprogression of malignant pleural effusion. CD4/CD8 ratio ≥ 1.93 in pleural effusion is a good predicting factor for PFS.

ALTERED EXPRESSION OF LUNG EPITHELIAL ION AND FLUID TRANSPORTERS DURING PROGRESSION OF PULMONARY HYPERTENSION IN THE MONOCROTALINE MODEL

Objective: Recent studies have evaluated a significant incidence of pleural effusions in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) co-diagnosed with isolated right-sided heart failure (RHF). Coincidence of pleural effusions and RHF in these patients significantly increased mortality rate during follow-up. However, mechanism of pleural effusions formation has not been fully explained. Therefore, we examined expression of lung epithelial ion and fluid transporters responsible for alveolar fluid clearance (AFC), which may contribute to lung fluid accumulation under pathological conditions and potentially formation of pleural effusions. Design and method: 12-weeks old male Wistar rats were subcutaneously injected with monocrotaline (60 mg/kg, MCT) or vehicle (CON). The relative expression of AFC transporters: Na+/K+-ATPase alpha1, alpha2, beta1, beta3 subunits, epithelial sodium channel (ENaC) alpha, beta, gama subunits, cystic fibrosis transmembrane conductance regulator (CFTR) were determined by RT-qPCR 1, 2, 4 weeks after MCT application and also in end-stage disease (animals sacrificed after acute health deterioration, ∼ 4 weeks after MCT application) where pleural effusions were observed. Results: Increase in lung weight was observed from second week after MCT application and was more profound in end-stage disease (by 26 % compared to fourth week, p &lt; 0.05). A downregulation of all three pore-forming subunits of ENaC was observed in end-stage disease, accompanied by downregulation of small beta3 subunit of Na+/K+-ATPase. Expression of catalytic alpha2 subunit of Na+/K+-ATPase gradually decreased with disease progression from first week after MCT (-80% in end-stage vs. CON, p &lt; 0.05). On the other hand, we observed upregulation of CFTR (by 80%) and beta1 subunit of Na+/K+ATPase (by 79% vs. CON, p &lt; 0.05) mainly in end-stage disease. Conclusions: Downregulation of lung epithelial ion and fluid transporters contributing to AFC is predominantly limited to higher stages of PH with a marked downregulation in end-stage. These expression alterations may contribute to overall lung weight increase observed in end-stage disease. However, observed early alpha2 subunit of Na+/K+-ATPase downregulation could participate on the pathogenesis of PH while upregulation of beta1 subunit and CFTR in end-stage disease could represent a compensatory mechanism.

A Retrospective Analysis of the Palliative Surgical Treatment in Patients with Malignant Pleural Effusion

Abstract Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea. Material and Methods: Clinical data from patients who were hospitalized at the Clinic of Thoracic Surgery, JFMED CU and Martin University Hospital, in the years 2015–2019 were retrospectively explored and statistically analyzed based on their medical records. Results: From the group of patients with proven MPE (n=67), 32 patients were male (48%) and 35 were female (52%). The mean age was 62.3 years (65.4 for males and 59.4 for females). The three most common primary malignancies were lung cancer (n=24), breast cancer (n=14), and kidney cancer (n=6). In 38 patients with MPE a talc pleurodesis via VATS was performed, with a median survival of 341 days (95% CI 256–859). Drainage following the talc slurry pleurodesis was performed in 10 patients with a median survival of 91.5 days (95% CI 64-NA). Ten patients with MPE underwent drainage only. The overall median survival time after all types of surgical interventions was 301 days (95% CI 207-389 days). Conclusion: Management of MPE depends on the patient´s prognosis. A definitive intervention is required in patients with a long-term survival, while in patients with a short life expectancy procedures leading to the shortest hospital stay are preferred. Videothoracoscopic procedures with pleurodesis represent an effective treatment for patients with symptomatic MPE with a good performance status, presence of lung re-expansion following pleural drainage or expected survival.

Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence-Based Review and Guidance.

Hepatic hydrothorax is the formation of transudative pleural effusion as a consequence of portal hypertension. Only a minority of cases resolve after sodium restriction and diuretics. Despite the relatively low incidence of 5-15% among patients with cirrhotic portal hypertension, the high morbidity and serious clinical implications associated with hepatic hydrothorax necessitate a well-defined treatment strategy to guide patient care. Management is typically multidisciplinary, involving hepatologists, interventional pulmonologists, interventional radiologists, surgeons, and other specialties. In this manuscript, we assemble a multidisciplinary team to critically review the available literature and provide an evidence-based guidance for management of hepatic hydrothorax.

IL-10 promotes malignant pleural effusion by regulating TH 1 response via an miR-7116-5p/GPR55/ERK pathway in mice.

IL-10, produced by a wide variety of cells, is a highly pleiotropic cytokine that plays a critical role in the control of immune responses. However, its regulatory activity in tumor immunity remains poorly understood. In this study, we report that IL-10 deficiency robustly suppressed the formation of malignant pleural effusion (MPE) and significantly enhanced miR-7116-5p expression in pleural CD4+ T cells. We demonstrated that miR-7116-5p suppressed IL-10-mediated MPE formation by inhibiting pleural vascular permeability as well as tumor angiogenesis and tumor growth. IL-10 promoted MPE formation by suppressing miR-7116-5p that enhances TH 1 response. We identified Gprotein-coupled receptor 55 (GPR55) as a potential target of miR-7116-5p, and miR-7116-5p promoted TH 1 cell function by downregulating GPR55. Moreover, GPR55 promoted MPE formation by inhibiting TH 1 cell expansion through the ERK phosphorylation pathway. These results uncover an IL-10-mediated pathway controlling TH 1 cells and demonstrate a central role for miR-7116-5p/GPR55/ERK signaling in the physiological regulation of IL-10-driven pro-malignant responses.

Discriminating transudates and exudates in dogs with pleural effusion: diagnostic utility of simplified Light’s criteria compared with traditional veterinary classification

ObjectivesTo determine whether the simplified Light’s criteria (ie, pleural effusion lactate dehydrogenase concentration and serum total protein) can identify the pathophysiology of pleural effusion formation in dogs, and to assess...

Demons-Meigs syndrome or cardiomyopathy: a difficult case of a differential diagnosis

The article presents an overview of the data related to Demons-Meigs syndrome and the clinical situation associated with a complex differential diagnosis between myocarditis with the formation of secondary cardiomyopathy and Demons-Meigs syndrome. A variety of clinical symptom complexes that are associated with Demons-Meigs syndrome is discussed. The concepts of classical and non-classical, full and incomplete Demons-Meigs syndrome are considered. The current views on the pathogenesis of the syndrome and the mechanism of the formation of ascites and pleural effusion are given.

Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center.

BackgroundPleural effusions represent a common complication after liver transplantation (LT) and chest drain (CD) placement is frequently necessary.Material/MethodsIn this retrospective cohort study, adult LT recipients between 2009 and 2016 were analyzed for pleural effusion formation and its treatment within the first 10 postoperative days. The aim of the study was to compare different settings of CD placement with regard to intervention-related complications.ResultsOverall, 597 patients met the inclusion criteria, of which 361 patients (60.5%) received at least 1 CD within the study period. Patients with a MELD >25 were more frequently affected (75.7% versus 56.0%, P<0.001). Typically, CDs were placed in the intensive care unit (ICU) (66.8%) or in the operating room (14.1% during LT, 11.5% in the context of reoperations). In total, 97.0% of the patients received a right-sided CD, presumably caused by local irritations. Approximately one-third (35.4%) of ICU-patients required pre-interventional optimization of coagulation. Of the 361 patients receiving a CD, 15 patients (4.2%) suffered a post-interventional hemorrhage and 6 patients (1.4%) had a pneumothorax requiring further treatment. Less complications were observed when the CD was performed in the operating room compared to the ICU: 1 out 127 patients (0.8%) versus 20 out of 332 patients (6.0%); P=0.016.ConclusionsCD placement occurring in the operating room was associated with fewer complications in contrast to placement occurring in the ICU. Planned CD placement in the course of surgery might be favorable in high-risk patients.