BACKGROUND: The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study was to identify the type of injury using the cytological-energy analysis of pleural effusions. METHODS: We analysed 635 samples of pleural effusions with predominance of neutrophils. We compared the values of the coefficient of energy balance (KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) catalytic activities in the following subgroups of patients: with transudative effusions, purulent pneumonia, chest empyema and after chest surgery with and without purulent complications. Statistical analysis was performed using the ANOVA Kruskal-Wallis test (p < 0.05 was considered as significant). RESULTS: We found the lowest KEB values in pleural effusions of patients with chest empyema and their gradual increases in patients with purulent pneumonia and with transudative effusions. We observed the highest LDH and AST enzymes activity in patients with chest empyema and their gradual decrease in patients with purulent pneumonia and with transudative effusions. LDH and AST enzymes activity was significantly higher in pleural effusions of patients after chest surgery with purulent complications compared with non-purulent cases. CONCLUSION: The most intensive inflammation and the most extensive tissue destruction in the pleural cavity were found in patients with chest empyema. Significantly better parameters were observed in patients with purulent pneumonia. The absence of serious inflammation and the absence of tissue destruction were typical for patients with transudative effusions. Finally, our results confirmed an anticipated higher tissue destruction in patients after chest surgery. Significantly worse injury was found in surgical patients with purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental material section.

• Klíčová slova
• coefficient of energy balance, complicated exudate, cytology of pleural effusions, empyema, exudate, inflammation, neutrophils, pleural effusions, pneumonia, transudate,
• MeSH
• aspartátaminotransferasy analýza   MeSH
• biologické markery analýza   MeSH
• empyém pleurální diagnóza   imunologie   metabolismus   MeSH
• energetický metabolismus * MeSH
• hrudní chirurgické výkony škodlivé účinky   MeSH
• L-laktátdehydrogenasa analýza   MeSH
• lidé MeSH
• neutrofily imunologie   metabolismus   MeSH
• pleurální výpotek diagnóza   imunologie   metabolismus   MeSH
• pneumonie diagnóza   imunologie   metabolismus   MeSH
• pooperační komplikace diagnóza   imunologie   metabolismus   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• aspartátaminotransferasy MeSH
• biologické markery MeSH
• L-laktátdehydrogenasa MeSH

• Klíčová slova
• Pulmonary disease, coefficient of energy balance, immunocompetent cells, local inflammatory response, pleural cavity, pleural effusion,
• MeSH
• cytologické techniky * MeSH
• energetický metabolismus * MeSH
• lidé MeSH
• pleurální výpotek metabolismus   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: To identify in patients with pleural effusion which procedures are most useful in separating malignant from nonmalignant pleural effusions and to identify which procedures most commonly lead to a definitive diagnosis. DESIGN: Prospective consecutive case series. SETTING: Pulmonary referral hospital in Prague, Czech Republic. PATIENTS: One hundred seventy-one adults between ages 18 and 70 years with a pleural effusion and a Karnofsky score of 70 or above. INTERVENTIONS: All patients underwent history, physical, pleural fluid cytologic study, laboratory evaluation of serum and pleural fluid, pleural biopsy, bronchoscopy, and lung scan and/or pulmonary arteriogram. RESULTS: In this series in which 45% of the patients had malignant effusions, 19% had paramalignant effusions, and 36% had benign diseases, the pleural fluid cytologic study was the best for establishing a diagnosis. The pleural fluid carcinoembryonic antigen (CEA) levels above 10 had a high specificity (90%) for malignancy but had low sensitivity (37%). The pleural fluid CEA level was increased only in 19% of patients with paramalignant effusions. Although there were statistically significant differences in the mean results on several biochemical tests of pleural fluid, none were very accurate in separating malignant from benign disease. CONCLUSION: From this study, we conclude that patients with an undiagnosed pleural effusion should be evaluated in an individualized stepwise manner. If malignancy is strongly considered, the initial three steps should be relatively noninvasive and include clinical evaluation and cytologic study.

• MeSH
• dospělí MeSH
• karcinoembryonální antigen analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• maligní pleurální výpotek diagnóza   MeSH
• mladiství MeSH
• pleurální výpotek diagnóza   etiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• karcinoembryonální antigen MeSH

Besides massive expression in inflammatory pleural effusions, inflammatory markers are also present in cancerinduced pleural effusions. Recent advances in cancer biology point to a role of inflammatory signaling in cancer and encourage reconsidering the diagnostic and prognostic value of inflammatory markers. Here an attempt was made to relate protein levels of inflammatory markers to underlying malignant processes in the pleural space. Pleural effusions from lung cancer patients (n=116) were subjected to a multifactorial analysis covering 13 inflammatory markers. The composition of tumor-associated effusions was compared with that of parainflammatory pleural effusions (n=30), transudates (n=18), and serum values, and evaluated in relation to cancer origin, histology, cytology, pleural involvement, treatment history, and survival time. Inflammatory markers were significantly expressed in pleural effusions of paraneoplastic origin when compared to transudates and most serum levels. Values in pleura-invading and metastatic tumor-associated effusions were typically higher than those of other tumors. Many markers correlated negatively with survival, most prominently IL-8 (r=-0.36, p=0.001) and VEGF (r=-0.35, p=0.001). It appears that most inflammatory markers are highly expressed in tumor-associated pleural effusions, reflecting to some extent tumor origin and localization. Despite the lower efficacy of inflammatory markers in the differentiation between exudative pleural effusions, some inflammatory markers may represent potential prognostic markers of malignant processes in the pleural space.

• MeSH
• analýza přežití MeSH
• lidé středního věku MeSH
• lidé MeSH
• maligní pleurální výpotek krev   chemie   diagnóza   MeSH
• mediátory zánětu analýza   krev   MeSH
• nádorové biomarkery analýza   krev   MeSH
• nádory plic krev   chemie   diagnóza   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• mediátory zánětu MeSH
• nádorové biomarkery MeSH

The authors applied the mathematical method of discrimination analysis in the differential diagnosis of tumourous and other pleural exudates, as well as for the differentiation of malignant and paramalignant exudates. The basis for the investigation were data obtained during a four-year prospective study of pleural exudates at the Second Clinic of Tuberculosis and Respiratory Diseases in Prague. The analysis was made using a programme elaborated by RNDr. Tomásek, CSc. on a Hewlett-Packard 2100S computer in IHE Prague. After processing of 38 parameters--from 138 patients (without data on the cytology of the exudate, biopsy of the parietal pleura, bronchoscopy and thoracoscopy) the computer selected nine parameters with the greatest discrimination value which made it possible to differentiate tumorous exudates from others in 84%. This concerned the following data: skiagram of chest on admission, CEA in the exudate, temperature, exudate known already before admission to Clinic, LDH in serum on logarithmic scale, general impression of disease during physical examination, red cell sedimentation rate on admission, volume of exudate, alkaline phosphatase in exudate. When it was possible to add to the analyzed parameters also examination of the tissue polypeptide antigen (TPA), the analysis could be performed in 61 subjects. In that case the discriminating capacity rose to 95%. Subsequently we entered in the programme 38 parameters from 88 patients with a tumourous exudate and sought the most suitable ones for differentiation of malignant and paramalignant exudates.(ABSTRACT TRUNCATED AT 250 WORDS)

• MeSH
• diferenciální diagnóza MeSH
• diskriminační analýza MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• maligní pleurální výpotek diagnóza   MeSH
• mladiství MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Multiple myeloma affects predominantly osseous spaces and the close vicinity of bones. A plasmacellular exudate is rare. The authors describe the course of plasmacellular leukaemia in a 68-year-old female patient where the first symptom of the disease was anaemia and a dextrolateral pleural exudate with a cytological finding of plasma cells. The exudate disappeared after the first cycle of chemotherapy and intrapleural administration of cytostatic. After the third cycle of chemotherapy remission of the disease was recorded which was, however, short. After three months' remission (six months after establishment of the diagnosis) the disease exacerbated violently, the dextrolateral exudate reappeared and gradually the insufficiency of the infiltrated bone marrow increased. The patient died one month after the relapse of the disease. The finding of a plasmacellular exudate must be considered the sign of a very poor prognosis and in that case very aggressive treatment is indicated.

• MeSH
• lidé MeSH
• maligní pleurální výpotek komplikace   diagnóza   MeSH
• plazmocelulární leukemie komplikace   diagnóza   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

It is not easy to discover the underlying cause for pleural effusion. Over a quarter of the pleural effusions remain unexplained by indirect methods of examination such as chemical, cytological or bacterial tests. Thoracoscopy however, shows impressive results and can be conducted under simple conditions. Different statistical collections allow for the assumption that pleural effusions due to cardiac disease and malignant conditions occur equally often. They are followed in frequency by infection diseases and the often misjudged effusion with pulmonary embolism.

• MeSH
• lidé MeSH
• pleurální výpotek diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Pleural effusion is a frequent reason for a pulmonologist's investigation. Many pulmonary and extrapulmonary causes of pleural effusion exist. Heart failure, pneumonia and malignancies are the most frequent among them. Laboratory examination of pleural liquid is a corner stone of diagnostics. We use various biochemical, microbiological, cytologic and other methods. The first step is a differentiation between transudate and exudate. If the laboratory examinations are unsuccessful, we can use invasive procedures - pleural biopsy and thoracoscopy. Despite all modern diagnostic methods the causes of about 15% pleural effusions remain unclear.

• MeSH
• lidé MeSH
• pleurální výpotek chemie   diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

In a group of 171 patients with pleural effusions included in a perspective study at the Second Clinic for Tuberculosis and Respiratory Diseases in Prague in 1986-1990, the authors evaluated the asset of examination methods for the diagnosis of different types of effusions. They compared differences between the group of patients with effusions associated with neoplastic diseases (group 1-108 subjects) with a group of patients with other types of effusions (group 2-63 subjects). They compared data in the case-history, physical examination, examination of the effusions and other auxiliary examinations. For significantly different parameters of blood examination (CEA, TPA, IgM, LDH) and the effusions (CEA, IgM, ALP) liminal values, specificity and sensitivity were assessed for differentiation of tumourous and other types of exudates. The authors compared also the required time and method of diagnosis in the two groups of patients. In group 1 cytology of the exudate, biopsy of the pleura and bronchoscopy were most valuable. In patients of group 2 in addition to the cytology of the exudate, biochemistry and bacteriology and auxiliary examinations were most important. The number of necessary diagnostic "steps" for assessment of the aetiology of exudates differed. Fewer steps were necessary for assessment of tumourous exudates. The groups differed as to treatment and survival of the patients.

• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pleurální výpotek diagnóza   etiologie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION: Pleural effusion is a frequent reason for a pulmonologist´s investigation. The cornerstone is to distinguish transudative pleural effusion from exudative pleural effusion. In the case of the exudative pleural effusion the next step is detection of malignant etiology of pleural effusion. We have a variety of any non-invasive or invasive examinations. The pleural biopsy is one of the most important methods for diagnostics of malignant pleural effusion. MATERIAL AND METHODS: Two hundred and twenty-two closed pleural biopsies (CPB) were performed in 208 patients with pleural effusion, where the cytologic examination of pleural fluid was negative. The authors evaluated the value of CPB for the diagnosis of malignant pleural involvement. RESULTS AND CONCLUSION: Total sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 63.1%, 100%, 73.9%, 100% and 52.8%, but in the group of mesotheliomas these results were 59.1%, 100%, 79.4%, 100% and 70.7%. The incidence of complications and representative sampling of the pleura was mentioned. The authors compared the diagnostic value and the incidence of complications of various diagnostic methods in malignant pleural involvement by data in the literature.

• MeSH
• biopsie MeSH
• cytodiagnostika * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• maligní pleurální výpotek patologie   MeSH
• odběr biologického vzorku MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH