Transudate Research Articles

Quantitative analysis of biochemical components in the suprachoroidal space fluid of choriodal detachment associated with rhegmatogenous retinal detachment

Objective To investigate the nature of the suprachoroidal fluid by detecting the concentration of total protein (TP), lactate dehydrogenase (LDH), albumin (ALB), total cholesterol (CHOL), total bilirubin (TBIL) in suprachoroidal liquid of patients who have rhegmatogenous retinal detachment with choroid detachment (RRDCD). Methods Eighteen RRDCD patients (18 eyes) who underwent vitrectomy were enrolled in this study. There were 10 males (10 eyes) and 8 females (8 eyes), 8 right eyes and 10 left eyes. There were 8 patients with age of ≤55 years, 10 patients with age of >55 years. There were 7 patients with duration of ≤30 days, 11 patients with duration of >30 days. There were 7 eyes with diopters of ≥−6.0 D, 11 eyes with diopters of <−6.0 D. There were 11 eyes with class C proliferative vitreoretinopathy (PVR), 7 eyes with class D PVR. Suprachoroidal fluid samples were collected from all the patients, and took preoperative serum samples as RRDCD group. Ten serum samples of normal people were set as control group. The concentration of TP, LDH, ALB, CHOL, TBIL in all the subjects were measured. The properties of the suprachoroidal fluid were identified by Light standard and concentration standard of ALB, CHOL, TBIL. Results There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from suprachoroidal fluid samples in the patients with different age, sex, eyes, diopter, PVR grade (P>0.05). There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from preoperative serum samples in the patients between RRDCD group and control group (P>0.05). There was no difference on the concentration of ALB and CHOL from suprachoroidal fluid samples and preoperative serum samples in the RRDCD patients (P>0.05), but there were significant differences on the concentration of TP, LDH, TBIL (P 0.05). Conclusion The suprachoroidal fluid of RRDCD patients composed of TP, LDH, CHOL and TBIL. The suprachoroidal fluid is more likely to be exudate. Key words: Retinal detachment/etiology; Choroid diseases/etiology; Retinal perforations/complications; Exudates and transudates

Sonographic Evaluation of Pleural Effusion

Background: Although at times small amounts of pleural fluid is detected on the lateral decubitus chest radiograph, this may be impossible to obtain in severely ill patients. Because of its ready availability and ability for bedside imaging, ultrasonography has become a crucial imaging modality not only in detecting the presence of pleural fluid but also as a guide to aspiration. Aims: To sonographically determine the nature of pleural effusions. To analyze predictability of both benign and malignant pleural effusions and to study statistical value of various ultrasound characteristics in differentiating exudative and transudative as well as benign and malignant effusions in correlation with thoracocentesis. Material and Methods: Sonographic feature as well as fluid cytology was evaluated. Following categorization into exudates or transudate as well as benign or malignant the diagnosis was then correlated biochemically. Results: Transudates were anechoic, while an anechoic effusion may be either a transudate or an exudate. Complex septation, internal echoes, thickened pleura or homogeneously echogenic patterns were always exudates. Sonographic findings of pleural nodules and associated parenchymal lesions in the lung and liver were indicative of malignancy. Conclusions: Ultrasound in addition to being highly sensitive for pleural effusion also aided in characterizing the nature and minimizing the complications during thoracocentesis. Pleural effusions were categorized into exudates and transudate as well as benign and malignant with a certain degree of confidence based on sonographic findings.

Diagnostic value of soluble triggering receptor expressed on myeloid cells-1 in pleural effusion

Objectives The aim of this study was to assess the value of the pleural fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the diagnosis of the etiology of pleural effusion. Background The accurate diagnosis of pleural effusion remains a challenging problem even after thoracocentesis and closed pleural biopsy. TREM-1 is a recently described molecule that plays an important role in myeloid cell-activated inflammatory responses. Patients and methods We measured sTREM-1 levels from 20 patients with transudative effusion, 20 patients with malignant effusion, 20 patients with tuberculous effusion, and 20 patients with parapneumonic effusion using a specific enzyme-linked immunosorbent assay technique. Result sTREM-1 levels were significantly higher in parapneumonic effusion (45.50 ± 13.21 ng/l) than tuberculous effusion (34.90 ± 10.51 ng/l) and in malignant effusion (15.37 ± 5.01 ng/l) than transudative effusion (6.75 ± 3.35 ng/l). Conclusion Our study suggests that sTREM-1 can differentiate between infectious effusions (parapneumonic and tuberculous) and noninfectious effusions (malignant and transudative effusions).

Computed Tomography in Differential Diagnosis of Exudative and Transudative Pleural Effusions

Objective: To differentiate between exudative and transudative pleural effusions by using CT attenuation values and CT appearances. Methods: The retrospective study reviewed 132 patients who were diagnosed of pleural effusions in 2007-2014. All patients were evaluated by chest CT images before or after pleural tapping within 2 days. Pleural effusions were classified as exudates or transudates based on Light’s criteria. 1 Pre-contrast and post-contrast CT images were reviewed by measuring the mean attenuation values of pleural effusions and the associated CT findings. Results: Pleural effusions were 112 exudates and 20 transudates. Exudate group had significant higher mean attenuation values, compared with a transudate, in both pre-contrast (12.8±5.0 HU vs. 9.4±5.2 HU; p<0.001) and post-contrast images (13.8±5.1 HU vs. 10.2±5.7 HU; p=0.006). For differentiation between types of pleural effusions, the CT attenuation cutoff value of 8.5 HU showed highest sensitivity of 84.5% and the cutoff value of 16 HU showed highest specificity of 95%, respectively. The CT findings of pleural nodule, pleural thickening and loculation were more common in exudates, compared with transudates with the statistical significance and specificity of those findings as high as 100%, 90%, and 75%, respectively. Conclusion: The mean attenuation values of ≥16 HU favor exudates. However, the use of CT attenuation values for differentiating types of pleural effusions alone, showed poor diagnostic performance. Correlation with clinical context and pleural fluid analysis are still essential. We suggest the three helpful CT findings for diagnosis of exudates which are pleural thickening, pleural nodules and loculation.

A study of respiratory manifestations in chronic kidney disease

Introduction: Diseases of the kidneys can intimately affect lungs by multiple pathological mechanisms, and adversely affect outcome in these patients. Objectives : To study the prevalence of various respiratory diseases in the patients with CKD. Methods: One hundred patients with CKD who were being treated at KIMS, Hubli, from 1 st October 2015 to 30 th June 2016 were considered for the study. Clinical evaluation and relevant investigations including chest radiography, USG chest, CT chest, sputum analysis, pleural fluid analysis and pulmonary function test were done. Echocardiography was done to assess left ventricular function. Polysomnography was done in selected patients. Results: Mean age of study population was 45.50± 13.25 yrs. Sex ratio was 55:45 (M:F). Respiratory diseases were prevalent in 70% of them, commonest being Pulmonary edema(67%), followed by pleural effusion (54%). Pleural effusion was predominantly right sided and transudative. Pulmonary tuberculosis was present in 6% and tuberculous pleural effusion in 2%. Pneumonia occurred in 5% of them. Pleural thickening was present in 11%. Pulmonary calcification was noted by chest X-ray and CT chest in 13%. Sleep apnea was present in 12 out of 20 patients studied. (60%). 2 patients with pneumonia and tuberculosis did not have classical symptoms. Conclusion: The prevalence of respiratory diseases is substantially high in patients with CKD and carries adverse outcome in relation to patient management.

Postoperative Pleural Effusions After Orthotopic Heart Transplant: Cause, Clinical Manifestations, and Course.

Postoperative pleural effusions are common in patients who undergo cardiac surgery and orthotopic heart transplant. Postoperative pleural effusions may also occur as postcardiac injury syndrome. Most of these effusions are nonspecific and develop as a harmless complication of the surgical procedure itself and generally have a benign course. Here, we investigated the cause and clinical and laboratory features of postoperative early and late pleural effusions in orthotopic heart transplant patients. We retrospectively reviewed the medical records of 50 patients who underwent orthotopic heart transplant between 2004 and 2015 at Baskent University. Patient demographics and clinical and laboratory data, including cause of heart failure, presence of pleural effusions at chest radiography in the first year after transplant, timing of onset, microbiologic and biochemical analyses of pleural effusions, and treatment strategies were noted. Mean age of patients was 39.22 ± 13.83 years (39 men, 11 women). Reason for heart failure was dilated cardiomyopathy in most patients (76%). Nineteen patients (38%) had postoperative pleural effusions, with 15 patients (78.9%) with pleural effusion during the first week after transplant. Of these, 4 patients had recurrent pleural effusion. A diagnostic thoracentesis was performed in 10 patients, with 4 showing transudative effusion and 6 showing exudative effusion secondary to infection (2 patients), postcardiac injury syndrome (1 patient), and hemothorax (3 patients). Aspergillus fumigatus was detected by quantitative culture from pleural effusion in 1 patient. Tube thoracoscopy drainage was performed in 10 patients (25%), and 2 patients received antibiotic therapy. Pleural effusions are frequent after cardiac transplant. Complications may occur in a small portion of patients, with most effusions being nonspecific and having a benign course with spontaneous resolution. Early diagnostic thoracentesis could improve postoperative outcomes in these patients.

Linezolid Induced Lactic Acidosis: A Case Report

Linezolid is an oxazolidinone antibiotic used to treat a variety of grampositive infections, including those due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci as well as nocardia species. Prolonged therapy with linezolid has been linked to rare instances of lactic acidosis and liver injury probably as a result of hepatic mitochondrial toxicity. The lactic acidosis due to linezolid has been linked to injury to hepatic mitochondria and with microvesicular steatosis, but is usually rapidly reversed with withdrawal of therapy. This case report is about a 70 year old female patient admitted in the Medical Intensive Care Unit (MICU) with the complaints of vomiting since two days,difficulty in breathing , facial puffiness and decreased urine output.ABG(Arterial Blood Gas) analysis showed elevated potassium,low sodium and correction started for the same. Patient had a history of taking tablet Linezolid and tablet Diclofenac since one month status post her spinal surgery. On the second day of admission in MICU, the patient was found to have Linezolid induced lactic acidosis from the ABG analysis with lactate 87mmol/L and HCO 3 -18mEq/L and linezolid was withheld. Lab results also showedanemia,thrombocytopenia,abnormal creatinine , blood urea nitrogen values and bone marrow suppression after the admission.Anemia and thrombocytopenia was treated using thiamine adjunctive therapy from day 2.Urine culture test showed presence of Amp C Klebsiella(colony forming units-CFU=80,000) and was prescribed Injection Clindamycin 600mg and Meropenem((1gm every8hourly). Acute Kidney Injury(AKI) was suspected but resolved with dialysis. As the patient's condition improved she was shifted to the general ward on the 8 th day but was found to have tachypenia and bradycardia thus intubated and mechanically ventilated.Gradually she became better but pleural effusion was noted in lung scan,tap was done and was transudative in nature.Therefore patient was extubated and later on 11 th day urine culture sensitivity showed Candida tropicalis(greater than 1 lakh fungal colonycount-FCC) for which Injection Fluconazole(400mg)was started.In the general ward her treated continued with intravenous antibiotics,regular medications and other supportive measures,improved with the treatment and was discharged in a stable condition. Conclusion: Physicians should be aware about the adverse effects of antibiotics and closely monitor for the effects before starting longterm therapy of antibiotics.

051. Diagnostic approach to pleural effusion

A pleural effusion is an abnormal collection of fluid in the pleural cavity. Pleural effusion is a common manifestation in a wide range of diseases, including pleural, pulmonary and extra-pulmonary disorders, where the most frequent of these are congestive heart failure, pneumonia and malignancy. This review provides a systematic approach to manage the patient with pleural effusion in order to have a correct diagnosis quickly and without additional invasive methods beginning with medical history, clinical examination, radiology, pleural fluid analysis and finally, if there is a need, a pleural biopsy and/or thoracoscopy. The first step of the fluid analysis includes differentiation transudate from exudates based on Light’s criteria and after that suggests the tests which are necessary for the further investigation of exudates (biochemical characteristics, cultivation, cytology, test for tuberculosis, immunological tests). These steps are very important because early diagnosis improves prognosis and minimizes complications.

Expression of CC-chemokine ligand 18 (CCL18) in the serum and pleural effusion of non-small-cell lung cancer patients and its regulatory effect on the differentiation of monocyte-derived dendritic cells

To compare the CC-chemokine ligand 18 (CCL18) expression in the serum and malignant pleural effusion (MPE) of NSCLC patients and explore its regulatory effect on differentiation of monocyte-derived dendritic cells (Mo-DC). CCL18 levels in the serum and MPE from 62 NSCLC patients were quantitated by immunoassay. CCL18 in sera from 26 healthy individuals, 28 exudative pleural effusions from inflammatory pulmonary diseases and 17 transudative pleural effusions from non-inflammatory diseases were used as control. Mo-DC was generated by culturing NSCLC-derived monocytes with GM-CSF and IL-4 in the presence or absence of CCL18. The mean fluorescent intensity (MFI) of CD14, CD80, CD83, CD86 and HLA-DR were analyzed by flow cytometry (FCM). Mo-DC was then co-cultured with purified T cells and the percence of CD25(+)FoxP3(+) cells was assayed by FCM. CCL18 levels in the sera of NSCLC patients and healthy individuals were (132.70 ± 15.52) ng/ml and (18.44 ± 0.99) ng/ml, respectively (P < 0.001). The levels of CCL18 in MPE, exudative PE and transudative PE were (155.6 ± 13.58) ng/ml, (190.4 ± 22.33) ng/ml and (20.89 ± 3.03) ng/ml, respectively. CCL18 in the MPE was significantly higher than that in transudates (P < 0.001), however, no significant difference was observed between CCL18 expression in exudative PE and MPE (P = 0.172). Of note, a moderate positive correlation (r = 0.421, P < 0.01) was observed between CCL18 levels in the paired MPE and serum of NSCLC. In the healthy control group, Mo-DC cultured in the presence of CCL18 showed 31.4 ± 15.8 (MFI) of CD14 expression, which was significantly higher than that in Mo-DC cultured in the absence of CCL18 (18.5 ± 8.9, P < 0.05). In contrast, the expressions of MFI of CD80, CD83, CD86 and HLA-DR were significantly decreased upon CCL18 induction (P < 0.05). In the NSCLC group, GM-CSF+IL-4+CCL18 induced a MFI of 45.2 ± 13.8 of CD14 expression in Mo-DC, which was also significantly higher than that of GM-CSF+ IL-4 induction (22.6 ± 10.5, P < 0.01). Similarly, the expressions of MFI of CD80, CD83, CD86 and HLA-DR were significantly decreased in the presence of CCL18 (P < 0.05). Furthermore, the MFI of CD14, CD83, CD86 and HLA-DR had significant differences between GM-CSF/IL-4/CCL18-induced Mo-DC derived from NSCLC patients and healthy control (P < 0.05). Finally, CD4(+) T cells co-cultured with NSCLC-derived, GM-CSF/IL-4/CCL18-treated Mo-DC had significantly higher percent of CD25(+)FoxP3(+) cells compared with that of CD4(+) T cells stimulated with Mo-DC induced by GM-CSF/IL-4(P < 0.01). CCL18 is present at a high level in MPE and serum of NSCLC patients complicated with pleural effusion and a moderate positive correlation exists between CCL18 levels in the two fluids. CCL18 inhibits maturation of Mo-DC, which consequently stimulates T cells to differentiate into CD25(+)FoxP3(+) regulatory T cells.

Combined detections of interleukin 27, interferon-γ, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy.

Previous studies reported interleukin-27 (IL-27), interferon-γ (IFN-γ), or adenosine deaminase (ADA) alone plays a helpful role in diagnosing tuberculous pleural effusion (TPE). The present study aims at comparing the diagnostic accuracy of pleural IL-27, IFN-γ, and ADA, and investigate the diagnostic accuracy of the combination of IL-27, IFN-γ, or/and ADA for differentiating TPE from pleural effusions with the other etiologies. The concentrations of IL-27, IFN-γ and ADA were simultaneously determined in pleural fluids and sera from 40 patients with TPE; 26 with malignant pleural effusion, seven with infectious pleural effusion, and eight with transudative pleural effusion by enzyme linked immunosorbent assay and colorimetric method. The corresponding biochemical indexs were also simultaneously determined. The concentrations of pleural IL-27 and IFN-γ in the tuberculous group were significantly higher than those in the malignant, infectious, and transudative groups. The concentrations of ADA in TPE were significantly higher than those in MPE or transudative effusions, while much lower than those in infectious effusions. Among these three biomarkers, IL-27 was the most effective for TPE diagnosis, with the cut off value of 900.8 ng/L. IL-27 had a high sensitivity of 95% and specificity of 97.6% for differential diagnosis of TPE from non-TPEs. Combinations of IL-27, IFN-γ and ADA measurements further increased the sensitivity or specificity up to 100%. Compared to non-TPEs, IL-27, IFN-γ and ADA all simultaneously increased in TPE; and among these three rapid detection methods, IL-27 appeared to be the best for distinguishing tuberculous from non-TPEs, especially from MPE. Combinations of the three markers (IL-27, IFN-γ and ADA) yielded the highest sensitivity and specificity. These findings suggest that the applications of a new biomarker, IL-27, alone or with IFN-γ and ADA, may contribute to more efficient diagnosis strategies in the management of tuberculous pleurisy.

Diagnostic and prognostic significance of survivin levels in malignant pleural effusion

We aimed to evaluate the diagnostic and prognostic value of measuring survivin levels, which is an inhibitor of apoptosis in pleural effusions. Group I, malignant (MPE) (n=51); Group II, tuberculosis (TPE) (n=18); Group III transudative (TE) (n=9) effusions were enrolled prospectively. We used ELISA to analyze 78 effusions. The value for the differential diagnosis and the correlation between survivin and survival in MPE were analyzed. Survivin level was 41.75±76.20 in MPE, 15.83±10.92 in TPE and 8.33±8.67 in TE. When the patients divided two groups as malignant and non-malignant pleural effusion (non-MPE), survivin level was significantly higher in MPE (41.75±76.20) than in non-MPE (13.33±2.05) (p=0.012). The cutoff value for survivin levels detected by ROC curve analysis was 7.5pg/ml, with sensitivity and specificity values of 72%, 44%, respectively. Survivin had no discriminative power in differentiating exudative effusions of MPE from TPE (p=0.405). There was no correlation between survivin level and age, sex, location, fluid pH, glucose, protein, albumine and ADA level while there was significant moderate correlation with fluid LDH (r=0.49; p<0.001). Survivin levels can distinguish patients who had poor prognosis (median survival 75 days, n=24) and those who had good prognosis (median survival 219 days, n=27, p=0.03) in MPE. In conclusion, survivin expression levels detected with ELISA had no discriminative power in differentiating exudative effusions included MPE and TPE. Elevated survivin levels are associated with poor survival in MPE. Our results suggest that survivin may be a potential prognostic marker in MPE.

Value of Prostate-Specific Antigen Elevated in Transudative Pleural Effusion for Diagnosis of Prostate Cancer-Induced Paramalignant Pleural Effusion

When evaluating pleural effusion of undetermined etiology, malignant disease cannot be ruled out even if the effusion is transudative. Measurement of tumor markers in transudative pleural effusion (TPE) may aid in diagnosis, but the exact utility of these markers is unclear. We report the case of a 78-year-old man with paramalignant pleural effusion (PMPE) due to prostate cancer diagnosed by measuring prostate-specific antigen (PSA) in TPE. Androgen blockade therapy was effective in treating the PMPE. We discuss the value of PSA elevated in TPE for diagnosis of prostate cancer induced-PMPE. doi: http://dx.doi.org/10.4021/jmc1322w

Relationship between Herpes simplex Virus Type-1 and Candida albicans in Pregnant Women with Aphthous Stomatitis in the oral cavity

Background: This study was aimed to show the relationship between Herpes simplex virus type-1 (HSV-1) and Candida albicans, and to determine HSV-1 antigen in saliva of aphthous stomatitis patients by immunoflourescent (IF), as well as to determine HSV-1 antibodies immunoglobulin G (IgG) in saliva samples by enzyme linked immunosorbent assay(ELISA)test ,in addition to study concentration of the total salivary protein. Materials and methods: Sixty pregnant women with aphthae and thirty healthy control subjects were included in the study. Saliva samples were taken from all the subjects and examined by direct IF and ELISA, and using the saliva swab samples for isolation of Candida albicans .The isolated colonies were identified by germ tube formation, growth at 45 oC, and measuring the total salivary protein. Results: The results of the present study showed that aphthous were most prevalent at age group(26-30) years. The most commonly affected mucosa are the labial mucosa, buccal mucosa, tongue, and rarely the soft palate and floor of the mouth. Positive IF results were observed in 53.33% in patients and 6.67% in healthy control, while in ELISA, the positive results were found to be 63.33% in patients and 6.67% in control subjects. There was significant difference between anti HSV-1 IgG Abs and total salivary protein. Conclusion: the present study show there was no difference between Candida albicans and HSV-1 .The present study indicated that HSV-1 was detected serologically in saliva of patients by ELISA and IF method .The results revealed positive association between HSV-1 and aphthous, and the virus may play a role in the occurrence of the aphthous. Saliva is regarded as a transudate of the serum and it contains the same antibodies as serum, and a similar range of IgG antibodies, but at a much lower concentration and it's easily available and simply examined. The total salivary protein may play a role in the defense against the virus.

The use of spectral CT imaging in characterization of pleural fluid: a new method to differentiate transudates from exudates

Objective To assess the feasibility of characterizing pleural fluid on the basis of spectral imaging features utilizing spectral CT imaging. Methods Gemstone spectral imaging(GSI) was used to examine 20 pleural fluids filled tubes (11 exudates and 9 transudates ) following diagnostic thoracentesis. Effusions were classified as transudates or exudates using laboratory markers based on Light criteria. CT values on 140 kVp QC image were compared between two groups. Using GSI viewer, various CT spectral imaging parameters (CT values on different energy level, effective-Z, iodine-water concentration,calcium-water concentration and calcium-fat concentration ) were calculated and compared between two groups. The difference of these spectral characteristic parameters was evaluated statistically by independent-samples t test. Results According to Light criteria, the mean CT value on QC image of exudates [ ( 19. 56 ±4. 10) HU ] was higher than that of transudates [ ( 13.44 ±3.46) HU] (t =3.002,P =0. 010).Difference of CT value was found more obvious in the lower keV. On 40 keV images, the difference of CT value of two groups was the largest, the mean value of exudates [ (47.49 ± 14. 60) HU ] was significantly higher than that of transudates[ ( 19. 76 ± 6. 85) HU ] ( t = 5.520, P = 0. 000). While On 140 keV, the mean CT value were (9.76 ±4. 16)and (6.22 ±3. 17) HU and the difference of the two group has no statistically significant difference (t =2. 107,P =0. 050). The mean slope rates of exudates (0.51 ± 0.23)was significantly larger than that of transudates (0. 18 ± 0. 08 ) ( t= 4. 287, P = 0. 001 ). The effective-Z (7. 89 ± 0. 16), iodine-water concentration [ (5. 74 ± 1.28 ) g/L], calcium-water concentration[ (7. 89 ±1.78) g/L] and calcium-fat concentration [ (25.95 ± 1.74) g/L] of exudates were significantly higher than those of transudates [ 7.67 ± 0. 07, ( 1.70 ± 0. 95 ) g/L, (2. 53 ± 1.37 ) g/L, ( 20. 82 ± 1.40 ) g/L ] ( t = 4. 080,6. 998,6. 546,6. 301 ,P ＜ 0. 05 ). Conclusions The spectral curve and spectral imaging parameters of exudates is found to be different from transudates. The low energy spectral imaging plays an important role in the characterization of pleural fluid. Gemstone spectral CT imaging provides a new multiparameter method to differentiate transudates and exudates. Key words: Pleural effusion; Exudates and transudates; Tomography, X-ray computed

Elevated soluble interleukin-2 receptor and interleukin-2 receptor positive cells in carcinomatous pleural effusions

Soluble interleukin-2 receptor (IL-2R) level and IL-2R positive (IL-2R+) cells were studied in twenty patients with carcinomatous pleural effusions. The mean value of soluble IL-2R level in carcinomatous pleural effusions was 2930 +/- 1722 U/ml and that in sera was 965 +/- 610 U/ml. Soluble IL-2R level in carcinomatous pleural effusions was found to be significantly higher (p less than 0.001) than that in sera of patients with carcinomatous pleural effusions and that in transudates. Serum soluble IL-2R level in patients with carcinomatous pleural effusions was found, to be significantly higher (p less than 0.001) than that in normal controls (264 +/- 70 U/ml). We also studied IL-2R+ cells in pleural fluids and peripheral blood of patients with carcinomatous pleural effusions. The mean percentage of IL-2R+ cells in carcinomatous pleural fluid lymphocytes was 22.8 +/- 17.8%, as compared with 3.0 +/- 2.2% in peripheral blood lymphocytes of normal controls (p less than 0.001). No significant differences were observed among the cell types of lung cancer examined (adenocarcinoma, squamous, small cell and large cell carcinoma) and no correlation among levels of soluble IL-2R and IL-2R+ cell in either pleural fluid or blood. Our results suggest that in patients with carcinomatous pleural effusions, T cell-mediated active immune mechanisms (IL-2/IL-2R system) against cancer cells are more active in pleural fluid than in peripheral blood.

Pleural fluid to serum cholinesterase ratio for the differential diagnosis of transudates and exsudates

연구배경 : 1972년 Light's criteria가 나온 이후 흉막액의 여출액과 삼출액의 감별에 이 방법이 주로 이용되어 왔으나 그 이후 여러 논문에서 많은 예의 오류가 나타나 여러 가지 흉막액의 감별율 위한 방법들, 즉 흉막액 cholesterol값, cholesterol값의 흉막액 및 혈청에서의 비용, 흉막액 및 혈청에서의 알부민 구배율, alkaline phosphatase값 등에 대한 연구가 있어왔으나 Light's criteria보다 더 나은 분류 방법이라고 밝혀진 것이 없었다. 이에 저자들은 흉막액 cholinesterase와 흉막액 및 혈청 cholinesterase값의 비율이 삼출액과 여출액에 대한 감별의 유용성을 알아보고자 본 연구를 시행하였다. 방법 : 흉막액 원인의 구분이 가능했던 43명의 환자를 대상으로 흉막액을 추출하여 Light's criteria, 흉막액 cholesterol값, 흉막액 및 혈청 cholesterol값의 비율, 흉막액으로 cholinesterase값, 흉막액 및 혈청 cholinesterase값의 비율 등을 측정하여 비교하였다. 결과 : 흉막액 원인의 구분이 가능했던 43명의 환자에서 33명이 삼출액, 10명이 여출액으로 분류되었다. 흉막액 cholinesterase값의 평균은 여출액이 335.0 U/L, 삼출액이 1,928.1 U/L(p=0.002) 이었고 2명(4.7%)에서 검사의 오류를 보였으며 흉막액과 혈청에서의 cholinesterase값의 비율의 평균은 여출액이 0.15, 삼출액이 0.56(p=0.002)이었고 1명(2.3%)에서 검사 오류를 보였다. 흉막액 cholesterol값의 평균은 여출액이 22.7 mg/dL, 삼출액이 86.1 mg/dL(p=0.002)이었고 1명(2.3%)에서 검사의 오류를 보였으며, 흉막액 및 혈청 cholesterol값의 비율에서의 평균은 여출액이 0.17. 삼출액이 0.73(p=0.002)이었고 1명(2.3%)에서 검사의 오류를 보였다. Light's criteria에서는 43례중 4례 (9.3%)에서 검사의 오류를 나타냈다. 결론 : 여출액과 삼출액의 감별 진단에 있어서 흉막액 및 혈청 cholinesterase비율이 유용할 것으로 사료되며 더불어 Light's criteria를 비롯한 다른 기준들과 병용 검사시 진단 율을 더 올릴 수 있을 것으로 사료된다. 【Background : The established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiating the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiating pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. Methods : A total of forty-three patients with known causes of the pleural of the pleural effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Ligt's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio, the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. Results : The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol 2.3% ; pleural fluid to serum cholesterol, ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum chlinesterase ratio, 2.3%. Conclusions : The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If fur1her studies confirm the results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and, if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.】

Evaluation of oral mucosal transudate for immunodiagnosis of Chagaś disease.

Anticorpos anti-Trypanosoma cruzi (isotipo IgG) foram detectados no transudato da mucosa oral (TMO) atraves de um ensaio imunoenzimatico. Foram estudados 21 individuos com doenca de Chagas cronica comprovada atraves de diagnostico clinico, eletrocardiografico, epidemiologico e sorologico: 10 com forma cardiaca, 2 com forma digestiva, 6 com forma mista e 3 com forma assintomatica. Sete individuos de area endemica, com sorologia negativa, constituiram o grupo controle. O soro destes grupos foi armazenado a -20 oC. A coleta de TMO de ambos os grupos foi realizada com o dispositivo OraSureâ seguindo orientacao do fabricante (OraSureâ , Epitope Inc., Beaverton, OR, USA). As amostras de TMO foram diluidas (1:2) e testadas em duplicata atraves de um ensaio imunoenzimatico da Abbott Laboratories para detectar anticorpos IgG contra doenca de Chagas. Vinte dos vinte e um pacientes chagasicos apresentaram densidade optica acima do limiar de reatividade e foram considerados positivos para doenca de Chagas. Nenhuma das amostras provenientes de individuos soronegativos foi positiva. A sensibilidade e especificidade foram de 95% e 100%, respectivamente. Estes resultados indicam que TMO podera ser utilizado como um fluido biologico alternativo para o diagnostico da doenca de Chagas. Nos estamos aumentando o numero de individuos para validar estes resultados incluindo a analise comparativa entre amostras de TMO e soro.

Saliva HIV Test Proves Highly Accurate

Do saliva tests for HIV really work? This blinded study from the National Naval Medical Center tested a commercially available device (OraSure) that collects a high concentration of oral mucosal transudate. An absorbent pad was placed between the lower …

A BETTER APPROACH TO DIAGNOSING ASCITES.

Ascitic fluid has traditionally been classified as either exudative (e.g., caused by malignancy, infection, or pancreatitis) or transudative (e.g., caused by cirrhosis, heart failure, or nephrotic syndrome) on the basis of the total protein concentration. Unfortunately, the traditional cutoff value of 2.5 …

Diagnostic value of ferritin measurements in patients with pleural effusions.

The diagnostic value of ferritin measurements has been evaluated in 59 patients with pleural effusions (PE). The Mean(+/- standard error [SE]) PE-ferritin level was 1913 +/- 720 ng/ml in 10 patients with nonmalignant nontuberculous (nonTB) exudates (Group I), 594 +/- 110 ng/ml in 14 patients with TB effusions (Group II), 1286 +/- 194 ng/ml in 28 patients with malignant exudates (Group III), and 280 +/- 60 ng/ml in 7 patients with transudates (Group IV). Significant difference was found between Group II and Group III (p less than 0.05). The mean (+/- SE) ratio of PE/serum (PE/S) ferritin in Groups I, II, III, and IV was 3.5 +/- 1.1, 10.5 +/- 5.1, 4.9 +/- 1.0, and 2.0 +/- 0.7, respectively, and it showed no significant difference among Groups I, II, and III. There were good correlations between PE-ferritin and PE-LDH or S-ferritin, but no correlation between PE-ferritin and PE-protein. PE-ferritin revealed a considerable overlap among the exudative groups, and was of no value in the differentiation between malignant and nonmalignant (Group I + II) exudates. In the discrimination between exudates and transudates, the diagnostic accuracy (86%) of PE-ferritin was inferior to those (all 98%) of PE-protein, PE-LDH, PE/S protein ratio, and PE/S LDH ratio. Using PE-ferritin greater than or equal to 500 ng/ml in distinguishing malignant exudates from TB effusions, the sensitivity was 79%, specificity 57% and accuracy 71%.(ABSTRACT TRUNCATED AT 250 WORDS)