scholarly journals Biomarkers in routine diagnosis of pleural effusions

2018 ◽  
Vol 87 (1-2) ◽  
Author(s):  
Tiva Nemanič ◽  
Aleš Rozman ◽  
Katja Adamič ◽  
Mateja Marc Malovrh
Keyword(s):  
Pleural Fluid ◽  
Biochemical Parameters ◽  
Biochemical Analysis ◽  
Pleural Effusions ◽  
Routine Diagnostics ◽  
Routine Diagnosis ◽  
Malignant Effusions ◽  
One Year ◽  
The University ◽  
Aetiological Spectrum

Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE) diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine diagnosis of PE.Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH), alpha amylase (AA), pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions.Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154) or infection (n = 108). In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %). Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005) and proteins (p < 0.0005), and higher pH (p < 0.0005) values in the paramalignant effusions.Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.

Biochemical Analysis of Neoplastic Versus Nonneoplastic Abdominal Effusions in Dogs

2004 ◽  
Vol 40 (5) ◽  
pp. 372-375 ◽  
Author(s):  
Derek D. Nestor ◽  
Sheila M. McCullough ◽  
David J. Schaeffer
Keyword(s):  
Prospective Study ◽  
Biochemical Parameters ◽  
Biochemical Analysis ◽  
Lower Glucose ◽  
Low Glucose ◽  
Malignant Effusions ◽  
Lactate Levels ◽  
High Lactate

This prospective study of 15 dogs evaluated biochemical parameters in abdominal effusions of neoplastic and nonneoplastic origin in an attempt to identify markers for malignant effusions. Dogs in the neoplastic group had statistically significant lower glucose concentrations (mean, 72.6 mg/dL versus 110.0 mg/dL; P=0.0431) and higher lactate levels (mean, 3.81 mmol/L versus 1.68 mmol/L; P=0.0377) in their abdominal fluid than did dogs in the nonneoplastic group, indicating that low glucose and high lactate in abdominal effusions may be markers for neoplasia.

scholarly journals Hyaluronic acid levels are increased in complicated parapneumonic pleural effusions

2015 ◽  
Vol 75 (3) ◽  
Author(s):  
T. Zaga ◽  
D. Makris ◽  
I. Tsilioni ◽  
T. Kiropoulos ◽  
S. Oikonomidi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracellular Matrix ◽  
Congestive Heart Failure ◽  
Hyaluronic Acid ◽  
Pleural Fluid ◽  
Inflammatory Process ◽  
Serum Levels ◽  
Pleural Effusions ◽  
Tnf Α ◽  
Malignant Effusions

Background and Aim. Hyaluronic acid (HA) is a component of extracellular matrix and may play a role in the pleural inflammation which is implicated in parapneumonic effusions.The aim of the current study was to investigate HA levels in serum and pleura in patients with parapneumonic effusions. Methods. We prospectively studied pleural and serum levels of HA in 58 patients with pleural effusions due to infection (complicated and uncomplicated parapneumonic effusions), malignant effusions and transudative effusions due to congestive heart failure. In addition to HA, TNF-α and IL-1β levels were determined in pleural fluid and serum by ELISA. Results. The median±SD HA levels (pg/ml) in pleural fluid of patients with complicated effusions (39.058±11.208) were significantly increased (p&lt;0.005), compared to those with uncomplicated parapneumonic effusions (11.230±1.969), malignant effusions (10.837±4.803) or congestive heart failure (5.392±3.133). There was no correlation between pleural fluid and serum HA values. Pleural fluid TNF-α levels (146±127 pg/mL) and IL-1β levels (133.4±156 pg/mL) were significantly higher in patients with complicated parapneumonic effusions compared to patients with other types of effusion (p&lt;0.05). No significant association between HA and TNF-α or IL-1β was found. Conclusions. HA may play a significant role in the inflammatory process which characterises exudative infectious pleuritis. Further investigation might reveal whether HA is a useful marker in the management of parapneumonic effusions.

scholarly journals Study on Oxidative Metabolic Changes to Differentiate Exudative from Transudative Pleural Effusions

1970 ◽  
Vol 1 (1) ◽  
pp. 38-43
Author(s):  
V Narsimha Reddy ◽  
V Anil Kumar ◽  
M Srinivas ◽  
V Narayana Reddy
Keyword(s):  
Oxidative Stress ◽  
Lactate Dehydrogenase ◽  
Pleural Fluid ◽  
Total Protein ◽  
Biochemical Parameters ◽  
Oxygen Species ◽  
Pleural Effusions ◽  
Glucose Levels ◽  
Protein Serum ◽  
Serum Ratio

The purpose of this present study was to differentiate transudates and exudates in pleural effusions. Oxidative stress has been associated with various respiratory disorders. Ninety patients of pleural effusions of diverse etiologies were participated in this study. Subjects underwent diagnostic thoracentesis and standard biochemical parameters (total protein, lactate dehydrogenase, glucose, MDA levels) were measured in pleural fluid and serum. MDA, total protein, lactate dehydrogenase (LDH), glucose levels in plural fluid were higher in exudates compared to transudates (p < 0.001). Total protein pleural fluid/ total protein serum ratio, LDH pleural fluid/LDH serum ratio and MDA pleural fluid/MDA serum ratio were raised in exudates compared to transudates (p < 0.001). The present study showed that oxidative stress was more in exudates compared to transudates, probably due to the production of reactive oxygen species and it may serve as a marker for differentiation between transudates and exudates in clinical practice. Key Words: Exudates, Melondialdehyde, Oxidative Stress, Pleural Effusion, Transudates    doi:10.3329/sjps.v1i1.1806 S. J. Pharm. Sci. 1(1&2): 38-43

Lactate dehydrogenase, creatine kinase, and their isoenzymes in pleural effusions

1991 ◽  
Vol 37 (11) ◽  
pp. 1909-1912 ◽  
Author(s):  
T Paavonen ◽  
K Liippo ◽  
H Aronen ◽  
U Kiistala
Keyword(s):  
Creatine Kinase ◽  
Lactate Dehydrogenase ◽  
Protein Content ◽  
Pleural Fluid ◽  
Clinical Diagnosis ◽  
Body Fluids ◽  
Pleural Effusions ◽  
Inflammatory Lesions ◽  
Malignant Effusions ◽  
The Mean

Abstract Lactate dehydrogenase (LD; EC 1.1.1.27) and creatine kinase (CK; EC 2.7.3.2) are widely distributed cytoplasmic enzymes. LD has five and CK has three isoenzymes distributed in different proportions in various tissues. The amounts of LD and CK and the distribution of isoenzymes in different body fluids are not thoroughly characterized. We have measured the total LD and CK concentrations and their isoenzyme distribution in pleural aspirates and in serum from 22 patients with benign conditions and from 14 patients with malignant effusions. In malignant pleural fluid, the mean total LD was 662 U/L; in benign conditions, it was nearly 5840 U/L with large variations (91-43 400 U/L) according to clinical diagnosis, the highest values being reached in inflammatory lesions. The mean total CK concentration in pleural fluid was close to the serum value in both groups of patients, as was the pleural CK isoenzyme distribution. The LD isoenzyme distribution in pleural effusions differed from that in serum in both groups, with LD-4 and -5 being the main isoenzymes in their pleural fluid specimens (greater than 42% of total LD). The total LD concentration correlated somewhat (r = 0.57) with the total pleural protein content. In conclusion, the pleural LD isoenzyme distribution, both in benign and malignant conditions, differs from that in serum, having shifted towards more anaerobic and embryonic isoenzymes (LD-4 and -5). Moreover, the greater the concentration of pleural total LD, the greater the proportion of LD-4 and -5. These data suggest that visceral or parietal pleural cells are rich in LD isoenzymes 4 and 5.

scholarly journals Massive Pleural Fluid Collection in Adult Nigerians

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Kelechi E. Okonta ◽  
Emmanuel O. Ocheli ◽  
Peter D. Okoh
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Pleural Fluid ◽  
Fluid Collection ◽  
Pleural Effusions ◽  
Short Survival ◽  
Southern Nigeria ◽  
Fluid Collections ◽  
One Year ◽  
A Prospective Study

Background. There are no available literatures on massive pleural effusions (MPE) in our country.Aim. To determine the aetiology of MPE and compare the mortality rate between malignant and nonmalignant MPE in adult Nigerians.Methods. A prospective study of all the patients diagnosed with nontraumatic pleural fluid collections for one year in two tertiary federal hospitals in Southern Nigeria. A total of 101 consecutive patients with pleural fluid collections were studied. Diagnoses were made by clinical features and laboratory and radiological investigations.Results. Forty-eight patients (47.5%) had MPE with a mean age of 43 years ± 14.04 and 35 were females. Thirty patients (62.5%) were diagnosed with nonmalignant conditions (21 from pulmonary tuberculosis (PTB) and 9 from other causes). Haemorrhagic pleural collections were from malignancy in 12 (30.8%) and from PTB in 6 (15.4%). Straw-coloured collections were from malignancy in 9 (23.1%), from PTB in 8 (20.1%), and from posttraumatic exudative effusion in 3 (7.7%). Compared with nonmalignant MPE, patients with malignant collections had higher mortality within 6 months (8/18 versus 0/30 with aPvalue of 0.000).Conclusion. The presentation of patients with nontraumatic haemorrhagic or straw-coloured MPE narrows the diagnosis to PTB and malignancy with MPE cases being a marker for short survival rate.

scholarly journals Determining The Etiological Factors in Pleural Fluid by Crp, Albumin And Procalcitonin Levels

2020 ◽  
Vol 3 (2) ◽  
pp. 880-885
Author(s):  
Hakan Celikhisar
Keyword(s):  
Differential Diagnosis ◽  
Pleural Fluid ◽  
Diagnostic Methods ◽  
The Other ◽  
Pleural Effusions ◽  
Albumin Ratio ◽  
Procalcitonin Level ◽  
Other Hand ◽  
Malignant Effusions ◽  
Serum Crp

Abstract   Aim: The Light criteria with a specificity of 72% and a sensitivity of 100% have led to further research into the detection of more specific diagnostic methods for transudate exudate separation. In this study, we aimed to evaluate whether pleural fluid and serum CRP, procalcitonin, on the other hand CRP / Albumin and Procalcitonin / Albumin ratios may be suggested as an alternative to Light criteria in the differential diagnosis of pleural effusions.   Material and Method: In this study, the pleural effusions of 121 patients who were aged ≥18 years were evaluated. The study was planned as a prospective cohort type study.   Results: Effusions were divided into two sub-groups as transudate (n:37) and exudate (n:84); and malignant (n:30) and non-malignant (n:91). Serum procalcitonin level of 0.035 was having a sensitivity of 0.726 and specificity of 0.964; on the other hand, pleural fluid procalcitonin level of 0.035 was having a sensitivity of 0.690 and specificity of 0.919. For serum procalcitonin /albumin ratio, 0.0104 value was having a sensitivity of 0.774 and specificity of 0.757 while for pleural fluid procalcitonin /albumin ratio of 0.019 value was having a sensitivity of 0.667 and specificity of 0.649.   Conclusion: Serum and pleural fluid procalcitonin levels and procalcitonin/ albumin ratio were having a significant role in differentiating transudate and exudate. However, procalcitonin, CRP or any other ratios obtained from these parameters were not useful in diagnosis of malignant effusions.  

Overuse of small chest drains for pleural effusions: a retrospective practice review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Pattraporn Tajarernmuang ◽  
Anne V. Gonzalez ◽  
David Valenti ◽  
Stéphane Beaudoin
Keyword(s):  
Health Centre ◽  
Radiology Department ◽  
Chest Drain ◽  
Pleural Effusions ◽  
Content Type ◽  
Mcgill University ◽  
Practice Review ◽  
Pleural Infection ◽  
Malignant Effusions ◽  
One Year

PurposeSmall-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The goal of this study was to determine the proportion of avoidable chest drains and associated complications when a strategy of routine chest drain insertion is in place.Design/methodology/approachWe retrospectively reviewed consecutive pleural procedures performed in the Radiology Department of the McGill University Health Centre over one year (August 2015–July 2016). Drain insertion was the default drainage strategy. An interdisciplinary workgroup established criteria for drain insertion, namely: pneumothorax, pleural infection (confirmed/highly suspected), massive effusion (more than 2/3 of hemithorax with severe dyspnea /hypoxemia), effusions in ventilated patients and hemothorax. Drains inserted without any of these criteria were deemed potentially avoidable.FindingsA total of 288 procedures performed in 205 patients were reviewed: 249 (86.5%) drain insertions and 39 (13.5%) thoracenteses. Out of 249 chest drains, 113 (45.4%) were placed in the absence of drain insertion criteria and were deemed potentially avoidable. Of those, 33.6% were inserted for malignant effusions (without subsequent pleurodesis) and 34.5% for transudative effusions (median drainage duration of 2 and 4 days, respectively). Major complications were seen in 21.5% of all procedures. Pneumothorax requiring intervention (2.1%), bleeding (0.7%) and organ puncture or drain misplacement (2%) only occurred with drain insertion. Narcotics were prescribed more frequently following drain insertion vs. thoracentesis (27.1% vs. 9.1%, p = 0.03).Originality/valueRoutine use of chest drains for pleural effusions leads to avoidable drain insertions in a large proportion of cases and causes unnecessary harms.

scholarly journals Profile of exudative pleural effusion in the region of Bhuj people

2018 ◽  
Vol 5 (4) ◽  
pp. 1057
Author(s):  
Vishal K. Desai ◽  
Rashmi S. Arora
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Demographic Data ◽  
Initial Step ◽  
Clinical History ◽  
Categorical Variables ◽  
Malignant Effusion ◽  
Pleural Effusions ◽  
Malignant Effusions ◽  
Exudative Pleural Effusion

Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.

Some Biological Applications of High Voltage Electron Microscopy

1974 ◽  
Vol 32 ◽  
pp. 298-299
Author(s):  
Hans Ris
Keyword(s):  
High Voltage ◽  
Chromosome Structure ◽  
Nerve Fibers ◽  
Good Resolution ◽  
High Voltage Electron Microscopy ◽  
Voltage Electron ◽  
University Of Wisconsin ◽  
High Voltage Electron ◽  
One Year ◽  
The University

The High Voltage Electron Microscope Laboratory at the University of Wisconsin has been in operation a little over one year. I would like to give a progress report about our experience with this new technique. The achievement of good resolution with thick specimens has been mainly exploited so far. A cold stage which will allow us to look at frozen specimens and a hydration stage are now being installed in our microscope. This will soon make it possible to study undehydrated specimens, a particularly exciting application of the high voltage microscope.Some of the problems studied at the Madison facility are: Structure of kinetoplast and flagella in trypanosomes (J. Paulin, U. of Georgia); growth cones of nerve fibers (R. Hannah, U. of Georgia Medical School); spiny dendrites in cerebellum of mouse (Scott and Guillery, Anatomy, U. of Wis.); spindle of baker's yeast (Joan Peterson, Madison) spindle of Haemanthus (A. Bajer, U. of Oregon, Eugene) chromosome structure (Hans Ris, U. of Wisconsin, Madison). Dr. Paulin and Dr. Hanna are reporting their work separately at this meeting and I shall therefore not discuss it here.

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