Gas chromatographically quantitated lactate in empyema and other pleural effusions
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Background: Pleural effusion is a common condition in pulmonary medicine.Determining the cause of the pleural effusion is a difficult task.The distinction between an exudate and a transudate is the first and the most important step in the differential diagnosis of a pleural effusion.Light's criterion have been previously used for classifying pleural effusion.There are multiple other biochemical markers which are available, the diagnostic accuracy of which is not well established and is a subject of debate.Aim: To compare the diagnostic value of the pleural fluid cholesterol, ratio of Pleural Fluid Protein/ Total Serum Protein in differentiating the pleural fluid into transudate and exudate.Materials & Methods: A total of 25 cases of pleural effusion due to different diseases were analysed using certain biochemical parameters like pleural fluid cholesterol, pleural fluid protein & its ratio with serum values were analysed.Result: The pleural fluid protein, its ratio to serum protein and pleural fluid cholesterol had excellent diagnostic accuracy in differentiating exudative pleural effusions from transudative effusions. Conclusion:The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion.The pleural fluid to serum protein ratio and pleural fluid cholesterol had excellent diagnostic accuracy in classifying the pleural fluid type.
Transudate
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The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess.Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed.A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6 ± 6.35 days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR = 2.30, p = 0.048), and larger diameter of the liver abscess (OR = 1.02, p = 0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR = 10.62, p = 0.044), bilateral pleural effusion (OR = 46.72, p = 0.012) and combined biliary tract inflammation (OR = 21.05, p = 0.040) were significantly associated with the need for invasive intervention including surgery on effusion.The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.
Pleural empyema
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A 28-year-old Gurkha soldier presented with signs of severe chest sepsis and respiratory distress. High-flow oxygen, broad-spectrum intravenous antibiotics and intravenous fluids were started immediately. Bedside thoracic ultrasound demonstrated a moderate right pleural effusion suggestive of an empyema. A pleural aspirate was borderline for pleural infection, therefore, a chest drain was inserted and the patient was transferred to high dependency. Within 48 h the patient clinically improved. Three weeks later, a persistently raised C reactive protein and indeterminate right lower lobe radiographic changes was observed. Video-assisted thorascopic surgery was subsequently performed. Although technically difficult, a large amount of pus was drained from the pleural cavity. The patient was discharged, returning to normal army duties 8 weeks later. Follow-up chest radiographs showed complete resolution of the empyema and no evidence of scarring. The CRP normalised to <1.
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Pleural empyema
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Background: C-reactive protein in both pleural fluid and serum has been found to be higher in tubercular pleural effusion than in other causes of pleural effusion.
Objectives: The main aim of this study was to find out the diagnostic value of C-reactive protein in patients withlymphocytic pleural effusion.
Methodology: A cross-sectional study was conducted in 90 patients with pleural effusion who underwent thoracocentesis at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. The complete biochemical tests of pleural fluid and serum were performed. The C-reactive protein concentrations of both pleural fluid and serum were then measured from samples from patients with lymphocytic exudative pleural effusion.
Results: Ninety patients with exudative lymphocytic pleural effusion were included. Male patients were 56 (62.2%) and female were 34 (37.8%) with the male to female ratio of 1.64. Mean age of the patients was 51±21.54 (Mean ± Standard Deviation). The pleural fluid C-reactive protein levels in tubercular pleural effusion were higher (48.87±24.19 mg/dl) compared to non-tubercular group (38.30±17 mg/dl; p<0.001). Similarly, the serum fluid C-reactive protein levels in tubercular pleural effusion were higher (29.60±13mg/dl) compared to non-tubercular group (18.14±9.2mg/dl; p< 0.001). The sensitivity of pleural fluid C-reactive protein level in diagnosing tubercular pleural effusion was 86%.
Conclusion: Simple and inexpensive test like C-reactive protein is useful in the diagnostic workup of lymphocytic pleural effusions. High C-reactive protein levels are very suggestive of tubercular pleural effusion.
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A pleural effusion results from the accumulation of abnormal volumes (>10–20 mL) of fluid in the pleural space. Pleural effusions are common and are associated with many different diseases, differential diagnosis of effusions, and details of pleural fluid analysis.
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Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light's criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19) and exudates (43). The parameters pleural fluid protein/serum protein ratio (pfP/sP), pleural fluid LDH/ serum LDH ratio, pleural fluid LDH (pfLDH) and pleural fluid cholesterol (pCHOL) were compared with clinical diagnosis with regard to their usefulness for distinguishing between pleural exudates and transudates. Results. The pCHOL values determined were for exudates, for transudates, the differences between the transudates and others are statistically significant ( ). It is seen that pfP/sP ratio has a sensitivity of 81.4% and specificity of 82.6%; pfLDH/sLDH ratio has a sensitivity of 86% and specificity of 94.7% and pCHOL with sensitivity of 97.7% and specificity of 100% for differentiating exudative and transudative PE. Conclusion. The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion.
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A recurrent unilateral pleural effusion developed without obvious cause in two patients with cirrhosis of the liver. By the demonstration of the rapid passage of a radiolabelled colloid from abdomen to thorax, these effusions were proved to be secondary to clinically undetectable peritoneal effusions. A diaphragmatic tear, which had occurred during a previous splenectomy and which was apparent only at autopsy, was the cause of peritoneopleural communication in one patient. Previous surgery could also have been responsible for the pleural effusion in the other patient.
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