Frequency Of Pleural Effusion Research Articles

Frequency of pleural effusion in dengue patients by severity, age and imaging modality: a systematic review and meta-analysis

BackgroundIdentification of pleural effusion (PE) in dengue infection is an objective measure of plasma leakage and may predict disease progression. However, no studies have systematically assessed the frequency of PE in patients with dengue, and whether this differs across age and imaging modality.MethodsWe searched Pubmed, Embase Web of Science and Lilacs (period 1900–2021) for studies reporting on PE in dengue patients (hospitalized and outpatient). We defined PE as fluid in the thoracic cavity detected by any imaging test. The study was registered in PROSPERO (CRD42021228862). Complicated dengue was defined as hemorrhagic fever, dengue shock syndrome or severe dengue.ResultsThe search identified 2,157 studies of which 85 studies were eligible for inclusion. The studies (n = 31 children, n = 10 adults, n = 44 mixed age) involved 12,800 patients (30% complicated dengue). The overall frequency of PE was 33% [95%CI: 29 to 37%] and the rate of PE increased significantly with disease severity (P = 0.001) such that in complicated vs. uncomplicated dengue the frequencies were 48% and 17% (P < 0.001). When assessing all studies, PE occurred significantly more often in children compared to adults (43% vs. 13%, P = 0.002) and lung ultrasound more frequently detected PE than conventional chest X-ray (P = 0.023).ConclusionsWe found that 1/3 of dengue patients presented with PE and the frequency increased with severity and younger age. Importantly, lung ultrasound demonstrated the highest rate of detection. Our findings suggest that PE is a relatively common finding in dengue and that bedside imaging tools, such as lung ultrasound, potentially may enhance detection.

Early identification of novel coronavirus (COVID-19) pneumonia using clinical and radiographic findings

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for identifying Mycoplasma pneumoniae pneumonia. Most COVID-19 pneumonia in non-elderly patients (aged <60 years) are classified as atypical pneumonia using the JRS scoring system. We evaluated whether physicians could distinguish between COVID-19 pneumonia and M. pneumoniae pneumonia using chest computed tomography (CT) findings. In addition, we investigated chest CT findings if there is a difference between the variant and non-variant strain. MethodsThis study was conducted at five institutions and assessed a total of 823 patients with COVID-19 pneumonia (335 had lineage B.1.1.7.) and 100 patients with M. pneumoniae pneumonia. ResultsIn COVID-19 pneumonia, at the first CT examination, peripheral, bilateral ground-glass opacity (GGO) with or without consolidation or crazy-paving pattern was observed frequently. GGO frequently had a round morphology (39.2%). No differences were observed in the radiological findings between the non-B.1.1.7 groups and B.1.1.7 groups. The frequency of pleural effusion, lymphadenopathy, bronchial wall thickening and nodules (tree-in-bud and centrilobular) was low. In contrast to COVID-19 pneumonia, bronchial wall thickening (84%) was observed most frequently, followed by nodules (81%) in M. pneumoniae pneumonia. These findings were significantly higher in M. pneumoniae pneumonia than COVID-19 pneumonia. ConclusionsOur results demonstrated that a combination of the JRS scoring system and chest CT findings is useful for the rapid presumptive diagnosis of COVID-19 pneumonia in patients aged <60 years. However, this clinical and radiographic diagnosis is not adapted to elderly people.

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis

Aim: To analyze the frequency of pleural effusion and theeffect on prognosis in children with acute bronchiolitis.&#x0D; Methods: A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients’age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment.&#x0D; Results: Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors.&#x0D; Conclusions: This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.

FATAL CONSEQUENCES OF THERAPEUTIC THORACENTESIS IN PATIENTS WITH SYSTEMIC SCLEROSIS

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Pulmonary complications are common and a leading cause of death in patients with systemic sclerosis (SSc). Pleural effusions, however, are rare. Thoracentesis is a common procedure, performed to reveal the cause of pleural effusion or to drain it and relieve dyspnea. Although generally considered a low-risk intervention, complications of thoracentesis can lead to increased morbidity and mortality. We Here by describe our experience with patients with SSc requiring therapeutic thoracentesis. CASE PRESENTATION: We describe three patients with SSc and symptomatic pleural effusion who required thoracentesis. All patients deteriorated shortly after the procedure and died. The patients all had advanced heart failure either from left heart disease and/or severe pulmonary hypertension. DISCUSSION: We assume that patients with SSc are at high-risk to develop complications after thoracentesis, most likely due to the low compliant lungs and the low elastance of the pleura, in addition to significant cardiac compromise as etiology for pleural effusions. CONCLUSIONS: Pleural effusion in patietns with SSc is associated with grave prognosis secondary to heart failure or pulmonary hypertension. In such patients thoracentesis should be done with caution, while measuring the pleural pressure, either invasively, or with noninvasive surrogates. Reference #1: Luo YF, Robbins IM, Karatas M, et al. Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases. Chest 2011; 140:42-7. Reference #2: Thompsom AE and Pope JE. A study of the frequency of pericardial and pleural effusions in scleroderma. Br J Rheumatol 1998; 37:1320-3. Reference #3: Bouros D, Pneumatikos I, and Tzouvelekis A. Pleural involvement in systemic autoimmune disorders. Respiration 2008; 75:361-71. DISCLOSURES: no disclosure on file for Yair Levy; no disclosure on file for aiman Natur; no disclosure on file for Tsvi Sirotkin; No relevant relationships by ori wand, source=Web Response

P4428Physical exercise during uncontrolled systemic arterial hypertension

Abstract Introduction Physical exercise reduces systemic arterial blood pressure and improves cardiac remodeling. However, the effects of exercise during uncontrolled arterial hypertension remains poorly understood. This study evaluated the influence of physical training on cardiac remodeling in untreated spontaneously hypertensive rats (SHR). Methods Four experimental groups were used: sedentary (W-SED n=27) and trained (W-EX, n=31) normotensive Wistar rats, and sedentary (SHR-SED, n=27) and exercised (SHR-EX, n=32) hypertensive rats. At 13 months old, the exercise groups underwent treadmill exercise five days a week, for four months. Echocardiogram was performed to evaluate cardiac structures and function. In vitro myocardial function was analyzed in left ventricular (LV) papillary muscle preparations. Myocardial collagen was quantified by histology and hydroxyproline concentration and antioxidant enzyme activity was assessed by spectrophotometry. NADPH oxidase activity was analyzed by lucigenin reduction. Protein expression was quantified by Western blot. Matrix metalloproteinases (MMP) activity was evaluated by zymography. Statistical analyzes: two factor ANOVA and Bonferroni or Kruskal-Wallis and Dunn tests. Results Systolic blood pressure was higher in SHR groups. Exercised groups had greater physical capacity. Frequency of heart failure features was higher in hypertensive groups than controls; SHR-EX had a lower frequency of pleural effusion and tachypnea than SHR-SED. Echocardiogram showed lower LV wall thickness, LV relative wall thickness, left atrium diameter, and relaxation time in SHR-EX than SHR-SED. Myocardial function was better in SHR-EX (positive derivative of developed tension) than SHR-SED. SHR-EX had higher antioxidant enzyme activity than SHR-SED. Lipid hydroperoxide concentration, myocyte diameters, and phosphorylated JNK and total IkB protein expression were higher in hypertensive than control groups. Hydroxyproline, malondialdehyde, NADPH oxidase activity, and protein expression of collagen III, lysyl oxidase, TIMP-1, total JNK, phosphorylated p38, phosphorylated and total p65, and phosphorylated IkB did not differ between groups. Interstitial collagen fraction, MMP-2 activity, and protein expression of total p38, and total and phosphorylated ERK were higher in SHR-SED than W-SED. Exercise reduced MMP-2 activity and phosphorylated ERK in hypertensive rats. Conclusion Physical exercise improves physical capacity, reduces the frequency of heart failure features, and attenuates cardiac remodeling in spontaneously hypertensive rats. In addition, exercise increases antioxidant enzyme activity, decreases ERK phosphorylation and MMP-2 activity, and attenuates total ERK protein expression. Acknowledgement/Funding Fapesp, CNPq, Capes and UNESP

Hepatic Hydrothorax in Patients with Decompensated Cirrhosis in Zagazig University Hospitals: A Cross-sectional and Single Center Study

Background and Study Aim : Hepatic hydrothorax is the presence of more than 500 ml of pleural effusion in a patient with liver disorder. The work aimed to study the frequency of Hepatic hydrothorax in patients with decompensated cirrhosis admitted to the Tropical Medicine department, Faculty of Medicine, Zagazig University (inpatients, outpatient and intensive care unit) trying to determine the frequency of this disorder. Patients and Methods: This study was performed on 208 decompensated cirrhotic patients (112 males and 96 females), their ages ranged from 27 to73 years old (53.8 ±7.09) between April 2013 to April 2014. Which were randomly divided into Group I included 182 decompensated cirrhotic patients without pleural effusion and Group II included 26 cirrhotic patients with pleural effusion. Clinical assessment, laboratory evaluation, plain chest x-ray and diagnostic paracentesis and pleurocentesis for cytological, biochemical analysis and bacteriological, biochemical and bacteriological analysis were carried out. Results: In this study; the frequency of pleural effusion in decompensated cirrhotic patients was

Increased risk of tuberculosis in patients with type 1 diabetes mellitus: results from a population-based cohort study in Taiwan.

The studies on the risk of tuberculosis (TB) in patients with type 1 diabetes mellitus (T1DM) alone are limited. We examined this relationship using a population-based retrospective cohort study. From claims data of the National Health Insurance system of Taiwan, we identified 5195 patients with T1DM newly diagnosed from 2002 to 2011 and 20,780 randomly selected controls without T1DM, frequency matched by age, sex, and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the risk of TB. The overall incidence of TB was 4.07-fold higher in the T1DM cohort than in the control cohort (1.18 vs 0.29 per 1000 person-years, P < 0.001). Compared with the controls, the Cox model estimated adjusted hazard ratios (HRs) of TB in patients with T1DM were greater in men than in women (4.62 vs 3.59) and in adults than in children (4.06 vs 3.37), but not significant. The adjusted HR was much greater for those with comorbidities than those without comorbidities (14.6 vs 1.62, P < 0.001). Compared with the controls, the patients with T1DM were also more likely to develop TB with multiple emergency room visits (adjusted HR: 116.1, 95% confidence interval [CI] = 43.8–307.4) or hospitalizations (adjusted HR: 86.5, 95% CI = 33.7–222.4). Patients with T1DM are at elevated risks of developing TB with much higher HRs for those with comorbidities, within the first year of diagnosis, and with frequent emergency cares or hospitalizations.

Clinical differences according to radiological patterns in childhoodMycoplasma pneumoniaepneumonia

Purpose: This study was conducted to evaluate the difference of clinical characteristics of pneumonia in children caused by Mycoplasma pneumoniae, according to their chest radiographic patterns. Methods: We analyzed medical records of 921 children who were admitted to Soonchunhyang University Buchon Hospital due to M. pneumoniae pneumonia from January 2008 to December 2011. Enrolled children were divided into 2 groups by radiological patterns: lobar/lobular pneumonia group (group 1) and broncho/interstitial pneumonia group (group 2). Results: The number of patients in group 1 was 295 (32%) and in group 2, 626 (68%). Lobar/lobular pneumonia occurred in older children compared to broncho/interstitial pneumonia (mean age, 6.4 years vs. 4.2 years; P=0.00). Group 1 had significantly longer durations of fever and hospitalization than group 2. The frequency of pleural effusion was significantly higher in group 1. Erythrocyte sedimentation rate and C-reactive protein values were higher in group 1. Coinfections with respiratory viruses were more frequent in group 2. The history of allergic diseases were more common in group 2 (P=0.006). In 2011, lobar/lobular pneumonia was more frequent and the duration of fever was longer compared with 2008.2010. Conclusion: In M. pneumoniae pneumonia, patients with lobar/lobular pneumonia were more older and had more severe clinical features and laboratory findings. Because there was an outbreak with severe clinical course in 2011, we wonder that the outbreak was related to the macrolide resistant M. pneumoniae. Careful attention about clinical course and consequences of patients with lobar/lobular pneumonia is required.

On the safety of low-dose dasatinib in comorbid and non-comorbid patients: what is real-life? (Reply)

We are writing in response to the Letter of Dr. Guiseppe Visani and colleagues, ‘The incidence of pleural and pericardial effusion is not higher in patients receiving dasatinib at low doses’.1 We agree that in our study, noncomorbid and comorbid patients and those with accelerated phase disease were included.2 We also agree that in patients with Ph+ chronic myeloid leukemia (CML) treated with low-dose dasatinib (50–100 mg/day), the incidence of pleural and pericardial effusions is lower (definitively not higher) compared to high-dose dasatinib (140 mg/day).3 This was also found in our patients.2,4 In addition, we agree that in ‘chronic phase-patients’ without comorbidity the frequency of effusion formation may be lower.5 Finally, first-line dasatinib at low dose6 may even be less toxic compared to second-line dasatinib used in pre-treated patients.3,5 However, unfortunately, the ‘real-life’ to which the authors refer in their letter usually includes both patients without and patients with comorbidities, and in the second-line setting, to which most published data and our data refer, many patients have suboptimal response or even show signs of disease-acceleration2–5 (then 140 mg dasatinib/day is often recommended). In addition, such patients tend to develop comorbidities such as infections and weight-loss during dasatinib.4 Therefore, we do not agree with the authors’ conclusion that our information is misleading, but would rather argue that their statement1 is questionable, as it would suggest that real life exists without comorbidities, drug resistance, or disease-acceleration. Where we agree is the fact that the frequency of pleural effusions in second-line patients treated with low-dose dasatinib is lower compared to second-line patients treated with high-dose dasatinib (140 mg/day). Notably, in our (small) patients’ cohorts, including both comorbid and non-comorbid patients, the difference in the frequency of pleural effusions is clearly visible:2,4 in fact, whereas 75% of patients at 140 mg daily developed pleural effusions (grade II or higher) over time,4 only 56% of those who started at 50 or 100 mg/day developed pleural effusions.2 Why these frequencies are still higher when compared to the available literature may have several explanations. One may be the fact that this side effect is accumulating over time. Another explanation may be under-reporting in clinical trials.7 Notably, in most studies, chest X-rays were only performed routinely until ‘month 6’, and later only if symptoms were noted,3,6 whereas in our center, all dasatinib-treated patients had repeated chest X-rays over the entire time period (at least once a year). In other words, most other published data refer only to the frequency of symptomatic pleural effusions. There may also be other reasons for under-reporting which we have discussed recently.7 Finally, we would like to state that we believe that a repeated chest X-ray should indeed be considered in both younger (non-comorbid) and older (often comorbid) patients: in older patients because of the comorbidity-associated risk, and in younger patients because they are potential candidates for stem cell transplantation. For such patients it may be a less favorable scenario if effusion-formation or viral infection/reactivation is overlooked before they are referred.

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis

AimTo analyze the frequency of pleural effusion and the effect on prognosis in children with acute bronchiolitis.MethodsA total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients'age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment.ResultsMean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors.ConclusionsThis study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.

Pleural Effusion in Dasatinib-Treated Chronic Myeloid Leukemia Patients after Imatinib Failure

Dasatinib, as a 2nd generation tyrosine kinase inhibitor, is an effective Bcr-Abl kinase inhibitor for chronic myeloid leukemia (CML) with more than 300-fold and 20-fold potency than imatinib and nilotinib, respectively. Through a series of phase I and II clinical trials, dasatinib has demonstrated durable efficacy in CML patients with resistance, suboptimal response, or intolerance to imatinib. However, some adverse effects from dasatinib therapy have been reported in several studies. Among them, pleural effusion is one of the most common adverse effects, and was reported in 15 to 30% of patients.We investigated the development of pleural effusion from 64 Korean patients registered in a single center for a phase II study which was approved by the institutional review committee and carried out in accordance with the Declaration of Helsinki with informed consent provided from patients. All the patients are under dasatinib therapy after failure of imatinib treatment (22 patients with intolerance and 44 patients with resistance). Median age was 44 years old (range, 18 to 65) and median duration of dasatinib therapy was 29 months (range, 0.5 to 41). The patients were in different phases including 30 in chronic phase (CP) and 30 in accelerated phase (AP) when they started dasatinib treatment.We found that 23 patients (36%) experienced pleural effusion of any grade (grade 1/2 in 22, grade 3/4 in 1) at least one time. Among the 23 patients, 14 (61%) patients experienced recurrent pleural effusion, and two of them showed a change in grade from grade 1 to 2. The median time to the first occurrence of pleural effusion was 18 weeks (range, 1 to 132), developing within the first 6 months and 12 months of treatment in 13 patients (57%) and in 15 patient (65%), respectively, while the adverse effect occurred even after 28 months (2.3 years) of treatment in 3 patients (13%).Age, gender, previous interferon a treatment, duration of imatinib treatment, and duration of dasatinib treatment were not significantly different between patients without pleural effusion and patients developed pleural effusion. However, disease phase when dasatinib therapy started showed significant difference (P=0.002) in the development of pleural effusion. Patients in AP showed higher cumulative % of pleural effusion in comparison with those in CP (16/34, 47% vs. 7/30, 23%).Daily dose amount and dose schedule also gave an influence on occurrence of pleural effusion. We used 4 different categories in dose amount and dose schedule; 100 mg QD (n=3), 140 mg QD (n=32), 50 mg BID (n=7) and 70 mg BID (n=22). Frequency of pleural effusion was higher in the patients treated with BID schedule than in QD schedule (56% vs. 22%, P=0.005), and also higher in the patients treated with 140 mg per day than in 100 mg per day, but not significant (39% vs. 20%, P=0.23). Among 4 categories, 70 mg BID showed relatively higher % of pleural effusion (64%, 14/22, P=0.006).To see whether dose amount or dose schedule can influence on efficacy, we investigate cytogenetic responses from patients. Portion of complete cytogenetic response (CCyR) was not significantly different in 100 mg doge group and 140 mg dose group (67% vs. 64%). Time to achieving CCyR showed no significant difference (P=0.21) between 100 mg dose group (median 3 months, range; 2 to 17) and 140 mg dose group (median 6 month, range; 1 to 18). In addition, dose schedule did not make any significant difference in portion of achieving CCyR between QD group and BID group (60% vs. 59%).Based on the observed characteristics of pleural effusion and analysis of cytogenetic response in this study, lower dose (100 mg) administration by QD can be proposed for dasatinib therapy to reduce any possible occurrence of pleural effusion. [Display omitted]

Serous effusions in malignant lymphomas: A review

Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20-30% in non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), the involvement of peritoneal and pericardial cavities is uncommon. Among lymphoma subtypes, T-cell neoplasms, especially the lymphoblastic lymphomas, more frequently involve the serous fluids. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in HD and direct pleural infiltration is the predominant cause in NHL. There is wide variation in rate of positive cytologic findings of NHL in pleural effusion (22.2-94.1%). Cytologic features of specific lymphoma subtypes such as lymphoblastic lymphoma, follicular center cell lymphoma, including Burkitt-type lymphoma, marginal zone lymphoma, MALT lymphoma, and anaplastic large-cell lymphoma, etc., have been described in the literature. The differential diagnostic problems of lymphomas in serous effusions include reactive lymphocytoses, early involvement by lymphomatous process, small round-cell tumors (SRCT), and presence of look-alike of Reed-Sternberg cells. To overcome these difficulties, various ancillary studies, including immunocytochemistry (ICC), morphometry, flow cytometry (FCM), and cytogenetics/molecular genetics (PCR, in-situ hybridization, and Southern blotting), have been performed on effusion specimens. ICC not only distinguishes lymphomas from reactive lymphocytoses and SRCTs, it significantly modifies the morphologic diagnosis to achieve a better classification of lymphomas. Combined morphology and immunophenotyping by FCM, has a sensitivity as well as specificity of 100%. Morphometry also distinguishes reactive lymphocytoses from malignant lymphoma with a high degree of sensitivity (>85%) and specificity (>95%). Limitations of individual ancillary techniques can be overcome by using multiple parameters. Although lymphomas rarely present as serous effusions without the involvement of other thoracic and extrathoracic sites, a small group of lymphomas called primary effusion lymphomas (PEL) exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. This body cavity based lymphoma (BCBL) is a distinct clinicopathologic entity and is found predominantly in AIDS patients with preexisting Kaposi sarcoma. In the absence of obstructive or infiltrative tumor mass, its pathogenesis has been attributed to stimulation by vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), leading to vascular leakage. Cytomorphologically, PEL is usually a large-cell lymphoma, which appears to bridge features of large-cell immunoblastic and anaplastic large-cell lymphoma (ALCL). Most of these cases comprise a unique subgroup of B-cell lymphoma, with features of both high-grade anaplastic and B-immunoblastic lymphoma, but T-cell and/or natural killer cell immunophenotypes are described. Its association with various viral DNAs has been studied in detail by molecular techniques. Pleural effusion due to lymphomas, either primary or otherwise, is considered as one of the factors adversely influencing overall survival. The presence of pleural effusion at the time of presentation is not only associated with extremely poor outcome of lymphomas, it is also a predictor of disease relapse after chemotherapy and decreased survival. When the patients of lymphomatous pleural effusions with and without mediastinal mass present in respiratory distress, thoracocentesis is the initial diagnostic and therapeutic choice in these patients. In such situations, cytology along with ancillary studies not only gives a quick diagnosis of lymphoma, but also offers prognostically significant information such as classification of lymphomas, its grade and immunophenotype, and presence/absence of viral DNAs and tumor lysis syndrome.

Pregnancy Outcome of Embryonic/Fetal Pleural Effusion in the First Trimester

This prospective observational study aimed to determine the frequency of pleural effusion in early pregnancy, and to learn whether it is associated with chromosomal abnormalities or a poor pregnancy outcome. The study group included 965 viable singleton pregnancies, confirmed by ultrasound at 7 to 10 weeks gestation. Serial studies were carried out if initial transvaginal sonography demonstrated pleural effusion. A total of 1063 pregnancies, excluding therapeutic abortions, were evaluated at 2 obstetric clinics. There were 135 spontaneous abortions (13%) in this series. Ultrasonography at the initial visit disclosed pleural effusion in 12 of 965 viable pregnancies (1.2%). All 14 effusions (2 were added from a previous report) were bilateral. Embryonic or fetal death occurred in 12 cases (86%) by 14 weeks gestation. Karyotypic abnormalities were present in 9 of 11 cases in which chorionic villi were sampled; 9 were 45,X. All but 2 of 14 pleural effusions resolved spontaneously by 9 to 12 weeks gestation along with cardiac activity. The 2 cases in which cardiac activity persisted ended in miscarriage at 9 weeks. In 3 cases, a viable pregnancy continued for 2 weeks or longer after pleural effusion had resolved spontaneously. The sonographic finding of embryonic/fetal pleural effusion in the first trimester reliably predicts poor pregnancy outcomes, notably karyotype abnormality and miscarriage.

The Frequency of Pleural Effusions after Bellovac Drainage following Coronary Bypass Grafting

Background: A common postoperative complication after CABG with internal mammary artery (IMA) harvest is the evolution of a pleural effusion. Our aim was to see if the intra-operative insertion of a Bellovac drain to the pleural cavity, with drainage continuing for 4-days post operation, eliminates the complication of pleural effusion. Methods: Using our computerised audit database, 500 consecutive patients were identified who had undergone CABG including at least one internal mammary graft by a single consultant at Blackpool Victoria Hospital. All these patients received Bellovac drainage for 4 days on the side of the harvested IMA. The chest X-ray reports were retrospectively collected from the hospital computer databases. The 4-day post-operative, and the 6-week post-operative films were found. In the cases where no consultant radiologist report was found J.D. reviewed the film, and any abnormalities were also reviewed by R.W.J.M. Results: Out of 500 radiographs, six patients (1.2%) died, 25 patients had no traceable record of a chest X-ray, 434 patients had an entirely normal chest X-ray and 461 patients had no effusion at 6 weeks. Six patients had a small effusion at 6 weeks, two had a moderate effusion successfully treated conservatively, and no patients had a pleural effusion that required drainage. Conclusion: In patients undergoing coronary arterial bypass grafting with Internal mammary artery harvest, the intra-operative insertion of a Bellovac drain on the side of the harvested IMA reduces the risk of postoperative pleural effusions

The frequency of pleural effusions after Bellovac drainage following coronary bypass grafting

Background: A common postoperative complication after CABG with internal mammary artery (IMA) harvest is the evolution of a pleural effusion. Our aim was to see if the intra-operative insertion of a Bellovac drain to the pleural cavity, with drainage continuing for 4-days post operation, eliminates the complication of pleural effusion. Methods: Using our computerised audit database, 500 consecutive patients were identified who had undergone CABG including at least one internal mammary graft by a single consultant at Blackpool Victoria Hospital. All these patients received Bellovac drainage for 4 days on the side of the harvested IMA. The chest X-ray reports were retrospectively collected from the hospital computer databases. The 4-day post-operative, and the 6-week post-operative films were found. In the cases where no consultant radiologist report was found J.D. reviewed the film, and any abnormalities were also reviewed by R.W.J.M. Results: Out of 500 radiographs, six patients (1.2%) died, 25 patients had no traceable record of a chest X-ray, 434 patients had an entirely normal chest X-ray and 461 patients had no effusion at 6 weeks. Six patients had a small effusion at 6 weeks, two had a moderate effusion successfully treated conservatively, and no patients had a pleural effusion that required drainage. Conclusion: In patients undergoing coronary arterial bypass grafting with internal mammary artery harvest, the intra-operative insertion of a Bellovac drain on the side of the harvested IMA reduces the risk of postoperative pleural effusions

Peritonite aguda experimental em ratos: modelo de bloqueio transdiafragmático com membrana celulósica

O objetivo deste trabalho foi analisar o efeito do bloqueio transdiafragmático na vigência de peritonite aguda infecciosa induzida por inoculação de suspensão bacteriana qualitativa e quantitativa predeterminada. Foram analisados 41 ratos, adultos, machos, da raça Wistar, com peso variando de 118 a 399 g. Os animais foram alocados em dois grupos: grupo A ou controle (n=19), e grupo B ou experimental (n=22). Os animais do grupo B, após indução anestésica inalatória, foram submetidos a laparotomia e bloqueio da superfície peritoneal diafragmática com membrana celulósica e mantidos sob condições ad libitum por 15 dias.. Após esse período, em ambos os grupos inoculou-se, por via percutânea na cavidade abdominal, suspensão bacteriana constituída de Pseudomonas aeruginosa 2,7 x 10(9) UFC/ml (American Type Culture Collection - ATCC 25853), na proporção de 1 ml de suspensão para cada 100 g de peso. Sempre que se detectou o óbito, o animal foi submetido a necropsia para avaliação macroscópica da cavidade peritoneal e pleural, bem como coleta de conteúdo pleural e punção intracardíaca para cultura. Os animais sobreviventes foram sacrificados após 48 horas e, também, submetidos a necropsia e coleta de material para avaliação bacteriológica. Verificaram-se em todos os animais sinais clínicos característicos do estado séptico evolutivo. A incidência de derrame pleural observada no grupo controle em relação ao grupo experimental foi, respectivamente, 18 (94,7%) e oito (36,4%), (p=0,0001). Na análise bacteriológica do derrame pleural e na hemocultura de ambos os grupos, isolou-se como agente único Pseudomonas aeruginosa em, respectivamente, 88,46% e 60,97%. Para a análise da curva de sobrevivência utilizou-se o método não-paramétrico de Kaplan-Meier, demonstrando maior sobrevida no grupo B (p=0,024; p=0,0211). Demonstrou-se, no presente estudo, que os animais submetidos a bloqueio transdiafragmático prévio com membrana celulósica apresentaram maior sobrevida e menor freqüência de derrame pleural, estatisticamente significante, quando comparados aos animais não submetidos ao bloqueio.

Benign Pleural Effusions in Long-Standing Diabetes Mellitus

We studied intractable pleural effusions in five patients with long-standing diabetes mellitus and an additional 40 patients with left ventricular systolic dysfunction to determine whether the frequency of pleural effusions is increased in diabetic patients and, if so, the relation of pleural effusions to left ventricular dysfunction. In our initial observations, effusions were benign, were not always associated with congestive heart failure (CHF), and reaccumulated following thoracentesis. Effusions associated with CHF persisted despite medical treatment and improvement of CHF. In our study of 40 patients with similar degrees of left ventricular dysfunction, the incidence of pleural effusions in diabetic patients was 83 percent and in our nondiabetic patients was 14 percent (p less than 0.001). We conclude that pleural effusions occur more commonly in diabetic than nondiabetic patients and may be related to left ventricular dysfunction and possibly other factors leading to increased effusion.

Paragonimiasis in Indochinese refugees. Roentgenographic findings with clinical correlations.

Twenty-five Indochinese refugees with paragonimiasis were reviewed. Thirteen patients were diagnosed by ova identification in sputum specimens, but 12 patients were diagnosed by an elevated complement fixation titer in conjunction with clinical and epidemiologic criteria. Roentgenographic lesions included diffuse (44%) and segmental (24%) infiltrates, nodules (20%), and cavities (20%). The classic ring shadow was present in only 8%. Of note was the frequency of pleural effusions (48%), which were massive in 6 patients and the sole manifestation in 5. Although tuberculosis should always be excluded, work-up of pulmonary effusions and infiltrates in immigrants from Southeast Asia should include a serologic and microbiologic search for paragonimiasis.

Massive bilateral hemorrhagic pleural effusions in chronic relapsing pancreatitis.

Bizarre pulmonary signs and symptoms may occur in association with pancreatitis. The frequency of pulmonary changes is estimated to be 14% to 17%. 1-4 Pleural effusions were first described in acute pancreatitis and more recently in chronic pancreatitis as well. 5-7 In the collective data from three large series of pancreatitis cases in the literature (518 patients), the frequency of pleural effusions was 5.2%, (27 patients). 1,3,4 Pleural effusions occurred on the left side in 18 patients and were bilateral in seven patients. Eight detailed descriptions of bilateral pleural effusions associated with pancreatitis have been recorded, a total of 15 cases. 7-12 In the patient to be described, chronic relapsing pancreatitis was associated with bilateral bloody pleural effusions. There have been two previous case reports of bilateral hemorrhagic pleural effusions in patients with pancreatitis. 7-11 Report of a Case A 52-year-old chronic alcoholic was admitted to the Manhattan Veterans Administration

The Initial Period of Artificial Pneumothorax: The Effect of Para-Aminosalicylic Acid and Dihydrostreptomycin on the Frequency of Pleural Effusion and on Pulmonary Function

An investigation is presented of the effect of antimicrobial agents on artificial pneumothorax therapy. Three groups of patients were observed for six months after the induction of pneumothorax: A) One hundred sixteen consecutive pneumothoraces without specific medication—the control cases. B) Eighty-two consecutive pneumothoraces in which all but seven of the patients had received para-aminosalicylic acid both before and after induction. C) Eighty-five consecutive pneumothoraces with PAS and dihydrostreptomycin given in combination both before and after induction. 1) A free space was found at induction or was obtained after adhesion section in 42 per cent of group A, 57 per cent of group B, and 56 per cent of group C. 2) “Spontaneous” pleural effusions formed in 15 per cent of group A, 9 per cent of group B, and 5 per cent of group C. 3) Adhesion section was followed by pleural effusion in 23, 18, and 15 per cent of the respective groups. 4) Pleural effusion persisted for more than two months in 27, 15 and 7 per cent. 5) Empyema developed in 3 per cent of the patients in group A but in none in groups B and C. 6) Impairment of ventilatory function due to pleural effusion was observed in 16 per cent of group A; in a number of these cases the impairment was severe. In groups B and C only 11 and 5 per cent showed any functional damage and this was invariably slight. 7) In addition to antimicrobial agents the patients in groups B and C who developed pleural effusion were treated with the writer's technique of “guided symphysis” and this contributed to the lack of functional impairment.