Effusion Group Research Articles

S20 Medical Thoracoscopy is Safe and Effective in Patients with Small or No Pleural Effusions

IntroductionCurrent BTS guidelines recommend the utilisation of medical thoracoscopy (MT) for cytology negative, exudative pleural effusions. A large pleural cavity is required between the lung and chest wall for safe...

Otoacoustic Emissions in Otitis Media with Effusion: Do They Carry any Clinical Significance?

Otoacoustic emissions have been advocated in the management of otitis media with effusion. However, otoacoustic emissions cannot differentiate different types of hearing loss. This study was conducted to find factor that can differentiate otitis media with effusion from other common causes of hearing loss in children. Children were enrolled in the study and divided in four groups consisting of 25 ears each after pure tone and impedance audiometry: (1) Otitis media with effusion group, (2) Normal ear group, (3) Sensory-neural hearing loss group, (4) Chronic suppurative otitis media group. Otoacoustic emissions were recorded and results were analyzed statistically. The normal hearing group had significant difference from other groups but total band reproducibility of transient evoked otoacoustic emissions did not show any statistical difference in the cases groups. In distortion product otoacoustic emissions, group 1 showed significant difference from group 3 and group 1 had significant difference from all other groups at 4kHz. The study did not find any factor that differentiates otitis media with effusion from other diseases. Although, distortion product otoacoustic emissions can indicate otitis media with effusion but impedance audiometry should be the main tool in the management of otitis media with effusion.

The differential diagnosis value of sICAM-1, VEGF and CRP in benign and malignant pleural effusion

Objective To discuss the differential diagnosis value of sICAM-1,VEGF and CRP in benign and malignant pleural effusion.Methods The levels of sICAM-1,VEGF and CBP were detected in 46 cases of malignant pleural effusion and 43 cases of benign pleund effusion.Results The levels and positive rates of sICAM-1,VEGF in malignant pleural effusion group was significantly higher than those in benign pleural effusion group ( t =7.125、6.271,x2 =33.929,all P ＜ 0.05 ),while CRP was significantly lower than that in benign effusion group ( t =5.963,x2 =31.430,all P ＜0.05).Conclusion The levels of sICAM-1,VEGF and CBP were significantly different between benign and malignant pleural effusion,which could be selected as the indexes for discriminating benign and malignant pleural effusion. Key words: Cell adhesion molecules; Angiogenesis; C-reactive protein; Pleural effusion

Knee effusion affects knee mechanics and muscle activity during gait in individuals with knee osteoarthritis

To test the hypothesis that knee effusion presence in those with knee osteoarthritis (OA) alters knee joint muscle activation patterns and sagittal plane mechanics during gait. Thirty-five patients with medial compartment knee OA were assessed for the presence of effusion using a brush test. Based on the results, they were assigned to the knee effusion (n = 17) and no knee effusion (n = 18) groups. Electromyograms from seven lower extremity muscles (lateral and medial gastrocnemius, vastus lateralis and medialis, rectus femoris and the lateral and medial hamstrings), leg motion and ground reaction forces were recorded during self-selected walking. Isometric knee extensor, plantar flexor and knee flexor strength were measured. Discrete measures from angular knee motion and net external moment of force waveforms were identified. Principal component analysis extracted electromyographic waveform features. Analysis of variance models tested for main effects (group, muscle) and interactions (α = 0.05). Bonferroni post-hoc testing was employed. No differences in age, body mass index, knee pain, Western Ontario McMaster Osteoarthritis Index scores, gait velocity and muscle strength were found between groups (P > 0.05). Individuals with effusion had a greater overall quadriceps activation and prolonged hamstring activation into mid-stance (P < 0.05). Knee joint flexion angles were higher (P < 0.05) and net external knee extension (KE) moments in mid to late stance lower in the effusion group. Quadriceps and hamstrings activation during walking were altered when effusions were present. Increased knee flexion (KF) angles and decreased KE moment in mid-late stance provide a mechanical explanation for the effect of joint effusion on muscle activation in those with knee OA.

Reduction in Postoperative High-Density Lipoprotein Cholesterol Levels in Children Undergoing the Fontan Operation

Despite the emerging relevance of high-density lipoprotein (HDL) in the inflammatory cascade and vascular barrier integrity, HDL levels in children undergoing cardiac surgery are unexplored. As a measure of HDL levels, the HDL-cholesterol (HDL-C) in single-ventricle patients was quantified before and after the Fontan operation, and it was determined whether relationships existed between the duration and the type of postoperative pleural effusions. The study prospectively enrolled 12 children undergoing the Fontan operation. Plasma HDL-C levels were measured before and after cardiopulmonary bypass. The outcome variables of interest were the duration and type of chest tube drainage (chylous vs. nonchylous). The Kendall rank correlation coefficient and the Wilcoxon rank sum test were used. There were 11 complete observations. The median preoperative HDL-C level for all the subjects was 30 mg/dl (range, 24-53 mg/dl), and the median postcardiopulmonary bypass level was 21 mg/dl (range, 14-46 mg/dl) (p = 0.004). There was a tendency toward a moderate inverse correlation (-0.42) between the postcardiopulmonary bypass HDL-C level and the duration of chest tube drainage, but the result was not statistically significant (p = 0.07). In the chylous effusion group, the median postcardiopulmonary bypass HDL-C tended to be lower (16 vs. 23 mg/dl; p = 0.09). After the Fontan operation, the plasma HDL-C levels in children are significantly reduced. It is reasonable to conclude that the reduction in HDL-C reflects reduced plasma levels of HDL particles, which may have pertinent implications in postoperative pleural effusions given the antiinflammatory and endothelial barrier functions of HDL.

POSTER PRESENTATIONS

POSTER PRESENTATIONS

Clinical significance of pleural effusion in the new influenza A (H1N1) viral pneumonia in children and adolescent

Parapneumonic effusion has been reported to develop either in typical bacterial infection or in viral pneumonia with bacterial co-infection and to cause death. Swine-origin influenza A (H1N1) virus infection can be accompanied with pleural effusion; however, there are no reports about the significance of pleural effusion in H1N1 pneumonia. We retrospectively analyzed both the clinical characteristics and the significance of pleural effusion associated with H1N1 pneumonia in children and adolescent. Eighty-nine patients who were admitted with H1N1 pneumonia were divided into two groups: 17 patients with pleural effusion (i.e., the effusion group), and 72 patients without pleural effusion (the non-effusion group). Lymphopenia (P = 0.030), elevation of the C-reactive protein (P = 0.026), and positive rate of anti-sptreptolysin O titer (P = 0.040) were significantly increased in the effusion group than in the non-effusion group. In addition, the need for treatment with both oxygen (P < 0.001) and oseltamivir (P = 0.013) was significantly increased in the effusion group. However, there was no significant difference between the two investigated groups in the duration of the treatment with intravenous antibiotics, the time of fever remission calculated from admission, and the days of hospital stay. Also, there was no documented bacterial co-infection in any of the studied groups. This result suggested that pleural effusion in H1N1 pneumonia could develop without bacterial co-infection and had mild clinical course.

Usefulness of pleural effusion antinuclear antibodies in the diagnosis of lupus pleuritis

We performed this study to determine sensitivity and specificity of pleural effusion antinuclear antibodies (ANA) at a titer of ≥1 : 160, and the ratio of pleural effusion to serum ANA of ≥1, to distinguish between pleural fluid from lupus pleuritis and other causes. A prospective study of 54 patients with pleural effusion (12 lupus pleuritis, seven parapneumonic effusion, 26 malignancy-associated pleural effusions, nine transudative effusions) was performed. ANA at a titer of ≥1 : 160 were found in 11 of 12 lupus pleuritis samples, and in four of 42 pleural effusions from non-systemic lupus erythematosus (SLE) patients. The pleural effusion ANA at a titer of ≥1 : 160 gave a sensitivity of 91.67% for lupus pleuritis, with a specificity of 83.33% when compared with all other pleural effusions, 90.91% when compared with exudative effusion (parapneumonic effusion and malignancy-associated effusion) and 55.56% when compared with the transudative pleural effusion group. Using the ratio of pleural effusion to serum ANA of ≥1, the sensitivity and the specificity decreased to 75.00% and 78.57%, respectively. This study provides further evidence that the pleural effusion ANA at a titer of ≥1 : 160 is a sensitive and specific diagnostic biomarker for lupus pleuritis in patients with lupus. However, pleural effusion ANA can occasionally be found in other conditions.

Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment

Current guidelines recommend discontinuation of oral anticoagulation treatment (OAT) and switch to heparin 2-5 days before catheter ablation of atrial fibrillation (AF). However, increasing evidence leans against the 'bridge therapy' and support continuation of OAT during the procedure. We evaluated the safety of AF ablation among patients with therapeutic OAT. The study population comprised 193 consecutive patients who underwent 228 AF ablation procedures guided by electroanatomical mapping. Periprocedural international normalized ratio was <2 (1.6 ± 0.3) in 103 cases (Group 1) and ≥2 (2.4 ± 0.4) in 125 cases (Group 2). Heparin (5000 IU bolus followed by continuous infusion through an open-irrigated ablation catheter) was used in both groups. No intracardiac echocardiographic guidance was used and activated clotting time (ACT) was not monitored. The incidence of major (intracranial bleeding, tamponade, bleeding that required surgical intervention, or blood transfusion) and minor bleeding complications and all thrombo-embolic events were registered during the 3-month follow-up. There was no statistical difference in major (P = 1.0) and minor complications (P = 0.74) between the groups. The bleeding complications included one surgically corrected groin haematoma in both groups (0.9%), 25 small haematomas at the puncture site (11 in Group 1 (10.7%) and 14 in Group 2 (11.2%), P = 0.90), and two minor pericardial effusions in Group 1. In Group 2, one patient had ischaemic stroke 16 days after the procedure. Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.

Value of D-dimer and CEAin pleural effusions from malignant perfusions

：Objective To explore thediagnostic value of malignant perfusions of D-D and CEA in pleural fluid.Methods Theclinical data of the levels of D-D, CEA in pleural effusion of 36 hospitalized patientswith benign pleural effusions and 32 patients with malignant perfusion were analyzedretrospectively. Rusults malignant pleural effusion of D-dimer and carcinoembryonicantigen levels were significantly higher than benign pleural effusion group [( 57.43 ±2.41 ) mg/L vs ( 12.63 ± 3.23 ) mg/L;( 73.2 ± 6.43 ) μ g/L vs ( 4.15 ± 2.35 ) μ g/L, P＜ 0.05 )],Joint detection can improve the sensitivity of diagnosingmalignant pleural effusion( 84.3％ )and accuracy ( 86.7％ )significantly higher than thosein benign perfusions. Conclusiong Combined measurement of D-D ,CEA in pleural fluid has apreferable clinical value in defferential diagnosis of benign and malignant malignantperfusiongs. Key words: D-dimer ( D-D ); Carcinoembryonic antigen ( CEA ); Pleusions effusions

Magnetic resonance imaging findings of shoulders in Parkinson's disease

The aim of this study is to evaluate shoulder disturbances in Parkinson's disease (PD) patients using magnetic resonance imaging (MRI) which is the best tool in the demonstration of complex shoulder pathologies; and to determine probable relations between shoulder pathologies and PD clinical features. Twenty-eight PD patients with a total of 56 shoulders were used as the study group while 13 age-matched cases with 26 shoulders were used as the control group (CG) in the study. Both patients with PD and the CG underwent shoulder MRI. The Hoehn and Yahr (H&Y) disability scale and Unified Parkinson's Disease Rated Scale (UPDRS) were used to determine the severity of the disease. Our results showed that patients with full-thickness supraspinatus (SSP) tear have statistically significant higher UPDRS (P = 0.012), tremor (P = 0.023), rigidity (P = 0.023), and total (P = 0.002) scores. Mild group patients (P = 0.045) showed significantly higher frequency resting tremor and subcoracoid effusion than those of severe group patients (P = 0.002). Subcoracoid effusion was observed in patients with significantly higher UPDRS (P = 0.045) and rigidity (P = 0.022) scores. When the resting tremor and subcoracoid effusion groups were compared according to the severity of the resting tremor but not according to the H&Y, higher frequency of full-thickness tear in SSP tendon was detected in the group of resting tremor (P = 0.053). Longer duration of disease was also observed in patients with full-thickness SSP tear (P = 0.029) and acromioclavicular joint changes (P = 0.018). Higher UPDRS, tremor, rigidity and total scores and longer PD duration appear as the predisposing factors for the development of shoulder disturbances in PD in this study.

Contrast-fluid level in the inferior vena cava (IVC niveau sign) in patients with acute type A aortic dissection: computed tomography findings during acute cardiac tamponade

The purpose of this study was to report a new computed tomography (CT) finding in acute cardiac tamponade: a contrast-fluid level in the hepatic inferior vena cava (IVC) during an arterial dominant phase CT study (IVC niveau sign) in patients with acute type A aortic dissection. We retrospectively reviewed CT studies with the diagnosis of proximal aortic dissection (Stanford type A) with acute cardiac tamponade. There were 12 patients enrolled in the study (6 women, 6 men; mean age 66 years). A total of 62 patients were selected as a control chronic pericardial effusion group to compare with the acute cardiac tamponade group. Among the 12 patients with acute cardiac tamponade, the IVC niveau sign was seen in 7 (58%). In the control chronic pericardial effusion group (n = 62), we identified the IVC niveau sign in only one patient (1.6%). There was a significant difference in the presence of the IVC niveau sign between the acute cardiac tamponade and chronic pericardial effusion groups (P < 0.0001). The presence of the IVC niveau sign suggests acute cardiac tamponade in patients with acute type A aortic dissection.

Endoscopic Grading of Adenoid in Otitis Media with Effusion

Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with otitis media with effusion may justify adenoidectomy in otitis media with effusion in the future. A prospective study was carried out at GMS Memorial Academy of ENT and head neck studies from 15th December 2005-April 2007. Study group comprised of 32 children with otitis media with effusion and control group of 28 children with clinically normal ear and nose. Rigid nasal endoscope was used for grading of adenoid in study and control group. The severity of otitis media with effusion was assessed by preoperative air-bone gap and thickness of the fluid aspirated from middle ear during ventilation tube insertion. In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy. Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid.

Pleural Effusions Following Cardiac Surgery: Prevalence, Risk Factors, and Clinical Features

<h3>Background</h3> Pleural effusion is a common complication of cardiac surgery, but its characteristics and predisposing factors should be documented further. Our objective was to determine the prevalence, characteristics, and determinants of clinically significant pleural effusions, defined as those requiring therapeutic pleural drainage according to clinical assessment. <h3>Methods</h3> The prevalence and characteristics of patients who had a pleural effusion within 30 days of undergoing coronary artery bypass graft, valve replacement, or both were analyzed retrospectively at our institution over a 2-year period. <h3>Results</h3> Among the 2,892 patients included in the study (mean age, 66 years; men, 2,139), 192 patients (6.6%) had experienced a clinically significant pleural effusion in the 30 days postsurgery. These effusions occurred after a mean (± SD) duration of 6.6 ± 5.9 days following interventions. Pleural fluid analysis was obtained in 114 patients (59.4%); all met the criteria for an exudate. Pleural fluid was hemorrhagic in 50% of cases. Age, body weight, baseline pulmonary function, and smoking status were similar between patients with and without effusion; however, the proportion of women; the number of patients with previous conditions of heart failure, atrial fibrillation, or peripheral vascular disease; and the number of patients receiving therapy with an anticoagulant or antiarrhythmic agent was higher in the pleural effusion group. Patients with pleural effusion had an increased prevalence of postoperative complications. <h3>Conclusions</h3> Pleural effusion is a common complication of heart surgery, is associated with other postoperative complications, and is more frequent in women and in patients with associated cardiac or vascular comorbidities and medications used to treat those conditions. <h3>Trial registration</h3> ClinicalTrials.gov Identifier: NCT00665015

The impact on survival of positive intraoperative pleural lavage cytology in patients with non–small-cell lung cancer

The aim of this study was to analyze intraoperative pleural lavage cytology results in patients with non-small-cell lung cancer and quantify the impact on survival and recurrence. From August 1992 through November 2006, pleural lavage cytology results before and after lung resection were both available in 2178 patients with non-small-cell lung cancer. We assessed the pre-pleural lavage cytology impact on survival, comparing with 9 factors available before lung resection by multivariate analyses. We also compared the impact with that of pleural dissemination or malignant pleural effusion. For post-pleural lavage cytology, we analyzed its survival impact in relation with 15 clinicopathologic factors, including those available after resection, by multivariate analyses. Pre-pleural lavage cytology proved to be a strong independent prognostic factor, but the 5-year survival rate was 37% in 65 patients without dissemination but with a positive pre-pleural lavage cytology, which was significantly higher than 12% in 86 patients with dissemination. When factors available after resection were combined, post-pleural lavage cytology showed a stronger survival impact than pre-pleural lavage cytology. Post-pleural lavage cytology was also a strong predictor of recurrence. The positive post-pleural lavage cytology group had a marginally, but not significantly, better survival compared with the malignant pleural effusion group. Almost all patients with positive post-pleural lavage cytology relapsed within 5 years. Pre-pleural lavage cytology is of less use in clinical practice. Post-pleural lavage cytology was a very strong independent prognostic factor, and almost all patients with positive post-pleural lavage cytology relapsed within 5 years. We propose that positive post-pleural lavage cytology disease should be classified to pathologic T4 and managed similarly to dissemination.

The utility of multi-detector computed tomography in the diagnosis of malignant pleural effusion in the patients with ovarian cancer

Purpose The purpose of this study was to retrospectively assess possible clinical predictors of malignant pleural effusion in patients with ovarian cancer. Materials and methods This review was performed on 38 ovarian cancer patients that showed pleural effusion in a CT scan and who underwent thoracocentesis before treatment. CT scans were obtained using a 4-channel multi-detector CT scanner. Fisher's exact test was used to determine the probability of malignant pleural effusion as a function of; amount of ascites, lymph node enlargement, amount of pleural effusion, pleural nodules, and pleural thickening. Results Sixteen (42.1%) of the 38 patients had malignant pleural effusion and malignant pleural effusion amounts were greater than those with nonmalignant effusion. Pleural nodules were more frequently found in the malignant pleural effusion group (eight [50%] patients) than in the nonmalignant group (zero [0%] patient) ( p < 0.001). Supradiaphragmatic lymph node enlargement (with short axis diameter 1 cm or more) was more frequent in malignant group (12 [75%] patients) than in the nonmalignant group (two [9.1%] patients) ( p < 0.001). Conclusion The probability of malignant pleural effusion in patients with ovarian cancer was found to be correlated with the amount of pleural effusion, the presence of pleural nodules, and supradiaphragmatic lymph node enlargement.

Tympanometry in infants with middle ear effusion having been identified using spiral computerized tomography

Purpose This study was carried out to evaluate the diagnostic value of 226 and 1000 Hz probe-tone tympanometry in infants with effusion in the middle ear. Methods For this study, we recruited 52 infants with ages 42 days to 6 months as clinical subjects in a hearing-ability screening program. After a spiral computerized tomography (CT) scan of the patients, we tested their hearing using tympanometry of 2 probe-tone frequencies: 226 and 1000 Hz. The patients were divided into 2 groups according to the results of the CT scan: group 1 patients had normal middle ears without fluid, and group 2 patients had ears with fluid. We recorded the tympanograms and their percentage of every type and compared the tympanometric results with CT to get the concordance rate between tympanometry and CT diagnose while obtaining the normal values of 1000 Hz tympanometric measures. Results The 226 Hz probe-tone tympanograms of middle ears with fluid differed greatly from those without. At 226 Hz, their tympanograms were single-peaked tympanograms (51.06%), double-peaked tympanograms (44.68%), flat tympanograms (2.13%), and negative-pressure tympanograms (2.13%) for the group with normal middle ears, but single-peaked tympanograms (77.19%), double-peaked tympanograms (19.30%), and flat tympanograms (3.51%) for the group with middle ear effusion. The 1000 Hz probe-tone tympanograms included single-peaked or flat-type tympanograms in both the normal middle ear group and the group with middle ear effusion. The group with normal middle ears was identified by spiral CT, and its tympanograms mostly had a single peak (97.87%) during 1000 Hz tympanometry. Tympanograms of the middle ear effusion group mostly had a flat curve (98.25%). When the Liden/Jerger classification system was used to evaluate the tympanograms, normal tympanograms were single-peaked, and flat tympanograms indicated middle ear effusion. According to this standard, the concordance rate between the 1000 Hz tympanometry (98.08%) and CT diagnosis was higher than when 226 Hz tympanometry (25%) ( P < .05) was performed, and the value of κ was equal to 0.961 between 1000 Hz tympanometry and CT diagnosis. Conclusions In clinical practice, 1000 Hz tympanometry, not 226 Hz, is recommended to determine the presence of middle ear fluid in infants younger than 6 months.

Tumor marker CEA, CA125, CA199 in the identification of malignant pleural effusion application

Objective To compare the pathology and cytology, pleural effusion observed in the CEA and CA199, CA125 levels to explore three types of tumor markers for malignant pleural effusion in the differenti-al diagnosis. Methods The selected 36 cases of patients with benign pleural effusion and 29 cases of patients with malignant pleural effusion. The use of fully automated chemiluminescence detection of all people selected in the pleural effusion CEA and CA199, CA125 levels and screening tests commonly used statistical indicators to e-valuate their differential diagnosis. Results malignant pleural effusion group CEA, CA125, CA199 level (117.83±139.43)μg/L, (51.26±22.71 U/ml), (138.29±152.31) U/ml were significantly higher than benign pleural effusion group (2.89±7.21)μg/L, (17.12±9.23) U/ml, (23.36±37.84)U/ml,(P<0.05). Screening results showed that a simple detection sensitivity of the three markers were lower, with sensitivity of the CEA 58.6 percent for the highest CA199 specificity of 94.4% percent for the highest of the three markers combined detection sensi-tivity as high as 89.7% P<0.01,specificity 97.2%. Consistency in the diagnosis of the three markers combined detection of Kappa as the supreme value of 0. 875. Conclusion Detection of a separate CEA, CA125, CA199 sen-sitivity of the CEA high CA199 more specific joint detection of CEA,CA125 ,CA199 may have a sensitivity of the effect of superimposed significantly improve the diagnosis of malignant pleural effusion validity. Can be used as be-nign and malignant pleural effusion differential diagnosis of secondary indicators. Key words: Tumor; Immunology; Pleural effusion

Pleural Fluid Interferon-Gamma (IFN-γ) Measurement as a Diagnostic Tool in Tuberculous Pleurisy

Introduction: Tuberculosis is one of the most common causes of pleural effusion (PE). However, the diagnosis of tuberculous pleurisy still remains difficult. Since M. tuberculosis isolation rates in tuberculous effusions are relatively low the histological and microbiological studies of pleural biopsy samples are usually required to confirm the diagnosis. Several biological markers have been proposed to enhance the effectiveness of diagnosing patients with tuberculous pleurisy. The study was undertaken to evaluate the diagnostic accuracy of pleural fluid IFN-γ concentration in differentiation between tuberculous pleural effusion (TPE) and non-tuberculous pleural effusion (nTPE). Material and methods: 94 patients (50 M and 44 F, mean age 59 ± 18, range 18–95 years) with PE were studied. All subjects underwent diagnostic thoracenthesis and extensive laboratory pleural fluid evaluation. Tuberculous pleural effusion was diagnosed in: (1) patients with positive pleural fluid or pleural biopsy culture and (2) patients with granulomas in the pleural biopsy specimen, after exclusion of other granulomatous diseases. IFN-γ level in pleural fluid was measured with commercially available immunoenzymatic assay (Quantikine Human IFN-γ Immunoassay, R&amp;D Systems, USA). Results: Tuberculous pleural effusion was diagnosed in 28 pts. The non-tuberculous pleural effusion group consisted of 66 pts, including 35 with malignant PE, 20 with parapneumonic effusion or pleural empyema, 5 with pleural transudates due to heart failure, and 6 with miscellaneous causes of PE. The mean concentration of IFN-γ was significantly higher in TPE than in nTPE (614.1 ± 324.5 vs. 15.1 ± 36.0 pg/ml, p &lt; 0.0001). At the cut-off value of 100 pg/ml the sensitivity and specificity of the test were 100% and 98.5% respectively. Conclusions: The pleural fluid concentration of IFN-γ was found to be highly sensitive and specific marker of tuberculous pleurisy.

Empyema and Effusion: Outcome of Image-Guided Small-Bore Catheter Drainage

Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema.