Pleural tuberculosis

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

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ROLE OF TUMOR MARKERS IN THE DIAGNOSIS OF MALIGNANT PLEURAL EFFUSIONS

10.36106/ijar/0102205 ◽

2020 ◽

pp. 1-2

Author(s):

Subhakar Kandi ◽

Ajay Kumar P ◽

Shravika Reddy Kandi

Keyword(s):

Differential Diagnosis ◽

Pleural Fluid ◽

Tumor Markers ◽

P Value ◽

Pleural Effusions ◽

Malignant Pleural Effusions ◽

Tuberculous Pleurisy

As an aid in the differential diagnosis of oxidative pleural effusions tumor markers were investigated. We measured carcinoembrionic antigen (CEA) and a glycoprotein CA 15-3 in the pleural fluid of 33 patients with carcinomatous pleural effusions and of ten patients with tuberculous pleurisy and other causes because we have frequently found those diseases to be associated with exudative pleuritis. CEA and CA 15-3 were significantly higher in carcinomatous pleural fluids than in tuberculous fluids (p value of 0.0287), therefore combined assay of CEA and CA 15-3 may be useful in distinguishing pleural effusions due to malignancies from those of tuberculous origin.

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The role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions

International Journal of Clinical Practice ◽

10.1111/ijcp.14051 ◽

2021 ◽

Author(s):

Nazli Gormeli Kurt ◽

Servan Gokhan ◽

Ozcan Erel ◽

Celal Gunes ◽

Ahmet Fatih Kahraman ◽

...

Keyword(s):

Pleural Fluid ◽

Pleural Effusions

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Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/571 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2783-2786

Author(s):

Vengada Krishnaraj S.P. ◽

Gayathri S. Mohan ◽

Vinod Kumar V ◽

Sridhar R

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Complete Blood Count ◽

Diagnostic Yield ◽

Diagnostic Value ◽

Parietal Pleura ◽

Pleural Biopsy ◽

Cardiac Evaluation ◽

Exudative Pleural Effusion ◽

Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

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The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.944 ◽

2018 ◽

Vol 88 (3) ◽

Author(s):

Cuneyt Tetikkurt ◽

Nail Yılmaz ◽

Seza Tetikkurt ◽

Şule Gundogdu ◽

Rian Disci

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Diagnostic Yield ◽

Final Diagnosis ◽

Exfoliative Cytology ◽

Pleural Effusions ◽

Cytologic Examination ◽

Collagen Vascular Diseases ◽

Female Ratio ◽

Exudative Pleural Effusion

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records. Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion. Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

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TNFα signalling predicts poor prognosis of patients with endometrial cancer

Carcinogenesis ◽

10.1093/carcin/bgaa034 ◽

2020 ◽

Vol 41 (8) ◽

pp. 1065-1073

Author(s):

Verena Wieser ◽

Samira Abdel Azim ◽

Susanne Sprung ◽

Katharina Knoll ◽

Johanna Kögl ◽

...

Keyword(s):

Endometrial Cancer ◽

Clinical Outcome ◽

The Cancer Genome Atlas ◽

Western World ◽

Low Grade ◽

Necrosis Factor Alpha ◽

Cancer Genome Atlas ◽

Factor Alpha ◽

The Impact

Abstract Endometrial cancer (EC) is the most common gynaecologic tumour in the Western world. Previous studies have implicated an imbalance of oestrogens and progestogens in the development of most ECs, while the role of low-grade tissue inflammation remains largely unexplored. We investigated the impact of tumour necrosis factor alpha (TNFα), a central mediator of inflammation and spermatogenesis-associated protein 2 (SPATA2), a regulator of TNF receptor signalling, on clinical outcomes in EC. We evaluated TNFA and SPATA2 transcript levels in 239 EC patients and 25 non-malignant control tissues. Findings were validated in a cohort of 332 EC patients from The Cancer Genome Atlas (TCGA). Expression of TNFA and SPATA2 was increased in EC when compared with control tissues (P < 0.001). TNFA expression correlated with SPATA2 expression in non-malignant (P = 0.003, rS = 0.568) and EC tissue (P = 0.005, rS = 0.179). High TNFA and SPATA2 expression were associated with poor recurrence-free survival (RFS; P = 0.049 and P = 0.018) and disease-specific (P = 0.034 and P = 0.002) survival. Increased SPATA2 expression was also associated with decreased overall survival (OS; P = 0.013). In multivariate analysis, both TNFA and SPATA2 were predictors of clinical outcome. The impact of SPATA2 on RFS and OS could be validated in the TCGA cohort. Our study demonstrates that ECs exhibit a TNF signature which predicts clinical outcome. These findings indicate that TNF signalling modulates the course of EC, which could be therapeutically utilized in the future.

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Role of Combined Pleural Fluid Cholesterol and Total Protein in Differentiation of Exudates and Transudates

Nepalese Medical Journal ◽

10.3126/nmj.v3i1.28330 ◽

2020 ◽

Vol 3 (1) ◽

pp. 282-285

Author(s):

Anupam Bista ◽

Suman Thapa ◽

Prasant Subedi ◽

Kiran Manandhar

Keyword(s):

Pleural Fluid ◽

Standard Method ◽

Total Protein ◽

Gold Standard ◽

Pleural Effusions

Introduction: Light's criteria had been the standard method for distinguishing exudative and transudative pleural effusions which misidentify 15-20% of transudates as exudates. This study aims to find out the role of combined pleural fluid cholesterol and total protein in distinguishing exudative from transudative pleural effusions and its applicability in Nepalese populations. Materials and Methods: Patients with pleural effusions were enrolled for the study. The combined pleural fluid cholesterol and total protein were compared with Light’s criteria and also compared with the diagnosis on discharge to find out their usefulness in categorizing the pleural effusions. Results: A total of 81 patients enrolled in the study, 42 (51.9%) were male. Based on Light’s criteria, 88.8% pleural effusions were found to be exudates and 11.1% were found to be transudates. Within the criteria, Light’s criteria categorized more pleural fluids as exudates than the diagnosis on discharge. Based on pleural fluid cholesterol >60mg/dL and protein >3g/dL for the classification of exudative and transudative pleural fluid, 62.9% out of 81 samples felled under the exudates and 37.03% pleural effusions under transudates with the sensitivity 87.9% and specificity 100%. Conclusions: Though Light’s criteria remain the gold standard to differentiate transudates and exudates, combined pleural fluid cholesterol and total protein give nearly comparable results without the need for simultaneous blood investigations.

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Point-of-Care Tests for Bladder Cancer: The Influencing Role of Hematuria

Advances in Urology ◽

10.1155/2011/937561 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Joerg Hennenlotter ◽

Severine Huber ◽

Tilman Todenhöfer ◽

Ursula Kuehs ◽

David Schilling ◽

...

Keyword(s):

Bladder Cancer ◽

Diagnostic Yield ◽

Point Of Care ◽

False Positives ◽

Two Systems ◽

Reliable Interpretation ◽

Point Of Care Tests ◽

The Impact

Introduction. Several point-of-care tests (POCT) are available for the diagnosis of bladder cancer (BC). We evaluate the impact of HU (hematuria) on performance of POCTs.Materials and Methods. Urine from 10 donors was diluted with blood from 0.5 to 0.00625%. BladderCheckR, BTAstatR, BCMR, and BTARtests were applied. Tests were additionally conducted in 54 patients with HU. HU was stratified according to the amount of erythrocytes (RBC)/μL using two systems: (1) no HU; mild microscopic HU; severe microscopic HU; gross HU; (2) I <25 RBCs; <250 II; ≥250 III. Results were compared to HU status and histopathology.Results. Gross HU became evident between 2090 RBCs/μL and 1065/μL. Addition of blood led to default tests in all 4: BladderCheckR0.25%; BCM 0.025%, BioNexia 0.00625%, and BTAstat <0.00625%. Rates of false positives for BladderCheck, BTAstat, BCM, and BioNexia were 5.9, 11.8, 0, and 1.8% without HU and 0, 66.7, 44.4, and 66.7% with HU. BTAstat, BCM, and BioNexia were independently influenced by HU (P<0.0002).Conclusions. NMP22-BladderCheck was most resistant to blood. The diagnostic yield of all others was significantly influenced by HU. A well-defined HU grading helps to define limits of HU for a reliable interpretation of BC-POCTs.

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