Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.
Objective To investigate the etiology of pleural effusions. Methods All adult patients with pleural effusions of unknown etiology admitted to this hospital between January 2011 and December 2013 were investigated. The etiological data of these patients with pleural effusion were retrospectively reviewed. Results During the 3-year period, 1 541 patients eventually were included in this study. The most frequent cause of pleural effusions was bacterial infection (38.7%), followed by malignancy (23.7%), congestive heart failure (13.1%), and tuberculosis (10.7%). The etiology of 120 patients (7.8%) remained uncertain. Conclusions The most frequent cause of pleural effusion is bacterial infection, followed by malignancy, cardiac failure, and tuberculosis. These four etiologies account for over 85 percent of all pleural effusions.
ObjectiveTo discuss the CT characteristics of pleural lung cancer, and analyze the reason for misdiagnosis. MethodsThe CT data of 8 patients with pleural lung cancer confirmed by postoperative pathology and treated in Renshou People's Hospital and Fist Affiliated Hospital of Chongqing Medical University between January 2010 and December 2013 were retrospectively analyzed. ResultsAmong the 8 cases of pleural lung cancer, 6 occurred on the left and 2 on the right; there were 3 nodular and 5 irregular masses; 6 had uniform density and 2 had irregular focus and relatively lower density; 4 had osteolytic destruction of adjacent ribs; 6 had pleural effusion; and 5 had mediastinal lymph nodes enlargement, in which 1 had multiple lymph node metastasis of left lung hilum, left supraclavicular region and left axillary. All the 8 cases were enhanced moderately. ConclusionPleural lung cancer has certain featured manifestations on CT. Analyzing the features carefully, considering clinical symptoms, and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.
Objective To investigate the expression of aquaporin-1（AQP-1） on pleura in rats with carrageenan-induced pleural effusion and explore the role of AQP-1 in effusion formation.Methods Fifty-six healthy Wistar rats were randomly divided into a normal control group and 6 pleuritis groups（6，12，24，36，48 and 72 h groups respectively）.The rat model of inflammatory pleurisy was induced by injecting l-Carrageenan into the pleural cavity.The expression of AQP-1 on pleura was detected with immunohistochemistry.The mRNA and protein expression of AQP-1 on visceral pleura and parietal pleura were measured by RT-PCR and Western blot assay respectively.The volume of pleural effusions were measured.Results The volume of pleural effusion was 2.10±0.22，4.10±0.15，4.40±0.36，3.20±0.27，2.60±0.18，0.12±0.02 mL in the 6，12，24，36，48 and 72 h pleuritis groups respectively.AQP-1 were mainly expressed on visceral and parietal pleural mesothelial cells and capillary endothelial cells，and significantly increased in all pleuritic rats The mRNA and protein expression of AQP-1 on parietal pleura increased after 6 h and reached peak level at 24 h in pleuritic groups.The mRNA and protein expression of AQP-1 on visceral pleura increased after 12 h and reached peak level at 24 h in pleuritic groups.The expression of AQP-1 on parietal pleura at 12 h and 24 h in pleuritic groups was correlated positively with the volume of pleural effusion（r=0.857，r=0.846，all Plt;0.01）.The expression of AQP-1 on visceral pleura at 24 h in pleuritic groups was positively correlated with the volume of pleural effusion（r=0.725，Plt;0.05）.Conclusion The expression of AQP-1 on pleura were increased in rats with e carrageenan-induced pleural effusion.AQP-1 may play a role in pleural fluid transportation in pleural effusion.
ObjectivesTo investigate the clinical and imaging characteristics of pleural effusion in patients with acute pulmonary embolism (APE).MethodsComputed tomographic pulmonary angiography (CTPA) scans and clinical data of suspected APE patients from January 2014 to December 2018 were analyzed.ResultsA total of 1024 suspected APE patients underwent CTPA examination in the imaging department of our hospital. Two hundred patients (19.5%) were diagnosed with APE. Imaging findings of pleural effusion were revealed in 70 cases (35.0%). The majority of APE patients without pleural effusion were males (82.3% vs. 64.3%, P<0.01), and the majority of APE patients with pleural effusion were females (35.7% vs. 17.7%, P<0.01). Most of the effusions were bilateral, small to moderate, with peripheral embolism (62.9%, P<0.05). Pulmonary consolidation, atelectasis and ground-glass opacity were common manifestations of CTPA. Compared with patients with simple pulmonary embolism, pulmonary embolism with pleural effusion was more common (62.9% and 33.8%, respectively, OR=3.279 and 95%CI 1.798 - 6.091, P<0.001). Diagnostic thoracic puncture was performed in 6 cases (8.6%). Pleural effusion was exudate in these 6 patients, with normal blood sugar and neutrophils predominated.ConclusionsAbout one third of APE patients are associated with pleural effusion, which most presented with small and bilateral pleural effusions. The main embolism associated with pleural effusion is peripheral embolism. There is a significant correlation between pulmonary consolidation and pleural effusion. Pleural effusion is mostly exudate and neutrophils often predominate.
Objective To compare the effects of heparin versus urokinase injection intrapleurally in the management of pleural thickening and adhesion due to tuberculous exudative pleurisy. Methods Sixty patients with tuberculous pleurisy were allocated into three groups randomly. Sodium heparin ( heparin group) , urokinase ( urokinase group) , and 0. 9% saline ( control group) were intrapleurally injected respectively. The concentrations of fibrinogen and D-dimer in pleural effusion were measured before and after the injection. The duration of absorption and the total drainage volume of pleural effusion were recorded. The pleural thickness and adhesion were observed two months after the injection. Results In 72 hours after the intrapleural injection, the concentration of fibrinogen( g/L) in the pleural effusion was significantly increased in the heparin group( 1. 13 ±0. 44 vs 0. 34 ±0. 19, P lt; 0. 001) , and significantly decreased in the urokinase group( 0. 25 ±0. 16 vs 0. 38 ±0. 15, P lt; 0. 05) when compared with baseline. Concentrations of D-dimer in the pleural effusions were significantly higher than those at baseline in both the heparin group and the urokinase group( 57. 0 ±17. 6 vs 40. 0 ±15. 4, P lt; 0. 05; 74. 5 ±16. 4 vs 43. 8 ±14. 9, P lt; 0. 001) . There were no significant differences in the absorption duration of pleural effusion among the three groups( P gt;0. 05) . The total drainage volume of pleural effusion was higher in the heparin group and the urokinase group compared to the control group( P lt;0. 01) . And the total volume of pleural effusion was significantly higher in the heparin group and the urokinase group than that in the control group( 2863 mL and 2465 mL vs 1828 mL,P lt;0. 01) . Two months after the intervention, the pleura were thinner[ ( 1. 37 ±0. 82) mm and ( 1. 33 ±0. 85) mmvs ( 3. 06 ±1. 20) mm, P lt; 0. 01] and the incidence of pleural adhesion was significantly lower[ 15% and 20% vs 50% , P lt; 0. 05] in the heparin and the urokinase groups than those in the control group.Conclusion Intrapleural heparin has similar effects with urokinase for prevention pleural thickness andadhesion in tuberculous pleurisy with good availability and safety.
ObjectiveTo analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test.MethodsThe clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis.ResultsThe positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0% and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974).ConclusionThe positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.
【Abstract】Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator( t-PA) and plasminogen activator inhibitor-1( PAI-1) in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion. t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ ( 52. 49 ±31. 46) ng /mL and ( 58. 12 ±23. 14) ng /mL vs ( 37. 39 ±22. 44) ng /mL, P lt; 0. 05] , but was not statistically different between malignant pleural fluid and transudative ( P gt; 0. 05) . PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ ( 164. 86 ±150. 22) ng/mL and ( 232. 42 ±175. 77) ng/mL vs ( 46. 38 ±16. 13) ng/mL, P lt; 0. 01] , but was not statistically different between malignant and infectious pleural fluid( P gt;0. 05) . D-dimer levels in the three types of pleural fluid were significantly different, which was ( 23. 66 ±25. 18) mg/L, ( 6. 36 ±10. 87) mg/L and ( 66. 90 ±42. 17) mg/L in malignant, transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was gt; 38. 7 ng/mL( area under ROC curve was 64. 0 ) , with sensitivity of 60. 0% , specificity of 63. 6%, positive predictive value of 66. 7%, negative predictive value of 56. 8% and accuracy of 61. 6% .The cutoff of D-dimer was lt; 27. 0 mg/L( area under ROC curve was 85. 5) , with sensitivity of 84. 8% ,specificity of 72. 5% , positive predictive value of 85. 3% , negative predictive value of 71. 8% and accuracy of78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination( t-PA + D-dimer) were 92. 5% , 60. 6% , 74. 0% , 87. 0% , 78. 1% , respectively.Conclusions The t-PA, PAI-1 and D-dimer levels are significantly different in the three types of pleural fluid. The detection of fibrinolytic parameters in pleural fluid, especially the value of D-dimer,may be helpful in the differential diagnosis of pleural effusion.
Objective To formulate an evidence-based treatment plan for a patient with malignant pleural mesothelioma.Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2007), PubMed (1996 to February 2007) and EMbase (1974 to February 2007) to identify the best available clinical evidence. Results Five randomized controlled trials, 4 systematic reviews and 1 health economic evaluation were included. According to the current evidence, as well as the patient’s clinical condition and preference, 5 cycles of raltitrexed plus cisplatin were given to the patient along with thoracic drainage and other symptomatic treatment. And the follow-up after 4 months indicated that this treatment plan was appropriate for the patient. Conclusion Evidence-based approaches helped us to prepare the most appropriate chemotherapy plan for this patient and will help improve the therapeutic results for patients with malignant pleural mesothelioma.
ObjectiveTo investigate the diagnostic value of internal medicine thoracoscope combined with pleural GeneXpert MTB/RIF for tuberculous pleurisy.MethodsEighty patients with tuberculous pleurisy admitted to hospital with pleural effusion were treated as tuberculous pleurisy group, and 20 patients with clinical diagnosis of malignant pleural effusion were used as control group. After admission to the hospital, the pre-operative examination of internal medicine thoracoscope were analyzed. All patients were extracted pleural effusion with thoracic puncture in order to send pleural tuberculosis smear and culture. Patients who had no contraindications were arranged internal medicine thoracoscope to get pleural effusion which will be sent to GeneXpert MTB/RIF and pathological tissue biopsy.ResultsIn the tuberculous pleurisy group, nine patients were positive in pleural tuberculous smear, and the positive rate was 11.3%; 4 patients were positive in pleural tuberculous culture, and the positive rate was 5.0%; 75 patients were diagnosed with pathological biopsy, and the positive rate was 93.8%; 69 patients were positive with pleural GeneXpert MTB/RIF, and the positive rate was 86.3%. The positive rate of internal medicine thoracoscopic pleural biopsy combined with pleural GeneXpert MTB/RIF could reached 96.3%. The pleural GeneXpert MTB/RIF lifampin resistance gene was positive in 5 patients, 4 of them were positive for tuberculosis culture, and the drug sensitivity results showed rifampicin resistance. In the control group, patients had negative result in pleural effusion tuberculosis smear, tuberculosis culture and the pleural GeneXpert MTB/RIF.ConclusionsThe diagnosis of tuberculous pleurisy by the combination of internal medicine thoracoscope and pleural GeneXpert MTB/RIF has high specificity and sensitivity. The diagnosis of tuberculous pleurisy by the combination of internal medicine thoracoscope and pleural GeneXpert MTB/RIF has high specificity and sensitivity, which has the value of rapid and accurate diagnosis and early guidance of anti-tuberculosis chemotherapy based on the early judgment of whether rifampin resistance exists.