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Zhaohui Tong - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value and safety of medical thoracoscopy in tuberculous pleural Effusion
Respiratory Medicine, 2015Co-Authors: Zhen Wang, Xiaojuan Wang, Yuan Yang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Abstract Background Differentiating tuberculous pleural Effusion from other lymphocytic pleural Effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural Effusion. Methods Between July 2005 and June 2014, patients with pleural Effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural Effusion were analyzed. Results During this 9-year study, 333 of 833 patients with pleural Effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. Conclusions Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural Effusion.
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efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural Effusions
Respiration, 2015Co-Authors: Xiaojuan Wang, Yuan Yang, Zhen Wang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Background: The differential diagnosis of pleural Effusions can present a considerable challenge, and the etiology of pleural Effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural Effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural Effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural Effusion in 342 (41.1%) patients, benign pleural Effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural Effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural Effusion.
Richard W. Light - One of the best experts on this subject based on the ideXlab platform.
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USE OF PLEURAL FLUID C-REACTIVE PROTEIN LEVEL AS A DIAGNOSTIC MARKER FOR PLEURAL EffusionS
Chest, 2009Co-Authors: Perlat Kapisyzi, Dhimiter Argjiri, Genc Byrazeri, Anila Mitre, Jeta Beli, Ylli Vakeflliu, Roland Kore, Elenka Shehu, Richard W. LightAbstract:Background: Our objective was to determine the usefulness of pleural Effusion C reactive protein levels in the di- agnosis of pleural Effusions. Patients and Methods: A comparison of serum and pleural fluid C-reactive protein (CRP) levels in different subgroups of 286 patients with pleural Effusion was made. We assessed prospectively the sensitivity, specificity, positive and negative predictive values, accuracy, Youden index, likelihood ratio and ROC curve of the test, for a period from February 2008 to November 2011. Results: Among 286 patients with pleural Effusion, 67 patients were included in the transudate group, 219 patients were included in the exudate group. In transudates the cut-off value of pleural fluid CRP ≤15 mg/L had a Youden index of 0.678 and the area under curve = 0.86 comparing with exudative pleural Effusions. In malignant pleural Effusions, the cut-off value of pleural fluid CRP ≤20mg/L had a Youden index of 0.728 and the area under curve = 0.89 comparing with tuberculous Effusions. In tuberculous Effusions, the cut-off value of pleural fluid CRP >20mg/L had a Youden index of 0.45 and the area under curve=0.96 comparing with malignant Effusions. The values of pleural fluid/blood CRP ratios had a very small Youden index and the area under curve in all subgroups of patients with pleural Effusion. Conclusions: Levels of CRP in exudative pleural Effusions less than 20 mg/L are strongly suggestive of malignant Effusion and chronic tuber - culous Effusion.A CRP pleural fluid level > 20mg/L almost excludes transudative pleural Effusion while the levels of CRP above 30mg/L are suggestive of an inflammatory etiology and almost exclude malignant pleural Effusion.
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diagnostic approach to pleural Effusion in adults
American Family Physician, 2006Co-Authors: Jose M Porcel, Richard W. LightAbstract:The first step in the evaluation of patients with pleural Effusion is to determine whether the Effusion is a transudate or an exudate. An exudative Effusion is diagnosed if the patient meets Light's criteria. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional transudate misidentified as an exudate by these criteria. If the patient has a transudative Effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative Effusion, attempts should be made to define the etiology. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative Effusions. Many pleural fluid tests are useful in the differential diagnosis of exudative Effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy.
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D-dimer levels in pleural Effusions.
Respiratory Medicine, 2006Co-Authors: Oner Dikensoy, Georgios T Stathopoulos, Richard W. LightAbstract:Summary Introduction D-dimer is a degradation product of cross-linked fibrin. We hypothesized that hemorrhagic pleural Effusions would have greater D-dimer levels than non-hemorrhagic pleural Effusions, and that persistently bloody Effusions would be distinguishable from thoracentesis-induced bloody Effusions by the D-dimer level. Methods Forty pleural Effusions were studied. D-dimer levels (measured by ELISA), red blood cell (RBC) count, white blood cell (WBC) count, lactate dehydrogenase (LDH), and protein level was measured for each Effusion. Ten Effusions, five non-bloody, and five bloody were studied for each of the following disease states: parapneumonic Effusion, congestive heart failure, post-coronary artery bypass grafting, and lung cancer. Results No significant difference of the D-dimer level was noted between bloody and non-bloody Effusions of different disease states ( P = 0.2 8 6 ). There was no significant difference in the median D-dimer levels between all the bloody and all the non-bloody Effusions ( P = 0.8 8 ). There was no significant difference ( P = 0.5 1 ) in D-dimer levels between five diseases groups when the bloody and non-bloody fluids were combined. The D-dimer levels did not correlate with the RBC count ( r = 0.1 1 , P = 0.4 8 ), WBC count ( r = 0.1 3 , P = 0.5 3 ), LDH ( r = 0.0 1 , P = 0.9 3 ), or protein levels ( r = - 0.0 1 , P = 0.9 3 ) in any of the groups. Conclusion Measurement of pleural fluid D-dimer levels does not distinguish persistently bloody Effusions from non-bloody Effusions, and does not aid in narrowing the differential diagnosis of an Effusion.
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PLEURAL EffusionS | Postsurgical Effusions
Encyclopedia of Respiratory Medicine, 2006Co-Authors: Richard W. LightAbstract:The majority of patients who undergo coronary artery bypass graft surgery develop a pleural Effusion that is usually predominantly left sided and small. Approximately 10% of patients develop a pleural Effusion that occupies more than 25% of the hemithorax and the main symptom is dyspnea. The pleural Effusions usually disappear after one to three therapeutic thoracenteses. The postcardiac injury syndrome occurs after various types of trauma to the heart, including blunt trauma, myocardial infarction, and cardiac surgery. It is characterized by the development of fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks posttrauma. The primary symptoms are chest pain and fever. The primary treatment is the administration of anti-inflammatory agents, and sometimes corticosteroids are required. After abdominal surgery, the incidence of pleural Effusion is approximately 50%. Most Effusions are small, but approximately 10% of patients develop moderate to large Effusions. The majority of patients postliver transplantation develop a pleural Effusion. The Effusions occupy more than 25% of the hemithorax in one-fourth of patients and usually are right sided or, if bilateral, larger on the right. There is increased pleural fluid production immediately after lung transplant because the lymphatics draining the pulmonary interstitial fluid are transected. Pleural Effusions are not apparent immediately postoperatively because chest tubes are in place. Pleural Effusions occurring more than a few weeks after lung transplantation are likely to be due to a complication of the transplant, such as acute rejection, chronic rejection, pulmonary infection, or lymphoproliferative disease.
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Eosinophilic pleural Effusions.
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Ioannis Kalomenidis, Richard W. LightAbstract:Eosinophilic pleural Effusions, defined as a pleural Effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural Effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural Effusions, pleural Effusions accompanying pulmonary embolism, and benign asbestos pleural Effusions are also among the common causes of eosinophilic pleural Effusion. No etiology is found in as many as one third of patients. Because studies evaluating different diagnostic approaches with eosinophilic pleural Effusions are lacking, the authors suggest that certain noninvasive and invasive diagnostic tools must be used based on the patient's clinical characteristics.
Zhen Wang - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value and safety of medical thoracoscopy in tuberculous pleural Effusion
Respiratory Medicine, 2015Co-Authors: Zhen Wang, Xiaojuan Wang, Yuan Yang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Abstract Background Differentiating tuberculous pleural Effusion from other lymphocytic pleural Effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural Effusion. Methods Between July 2005 and June 2014, patients with pleural Effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural Effusion were analyzed. Results During this 9-year study, 333 of 833 patients with pleural Effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. Conclusions Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural Effusion.
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efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural Effusions
Respiration, 2015Co-Authors: Xiaojuan Wang, Yuan Yang, Zhen Wang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Background: The differential diagnosis of pleural Effusions can present a considerable challenge, and the etiology of pleural Effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural Effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural Effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural Effusion in 342 (41.1%) patients, benign pleural Effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural Effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural Effusion.
Xiaojuan Wang - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value and safety of medical thoracoscopy in tuberculous pleural Effusion
Respiratory Medicine, 2015Co-Authors: Zhen Wang, Xiaojuan Wang, Yuan Yang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Abstract Background Differentiating tuberculous pleural Effusion from other lymphocytic pleural Effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural Effusion. Methods Between July 2005 and June 2014, patients with pleural Effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural Effusion were analyzed. Results During this 9-year study, 333 of 833 patients with pleural Effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. Conclusions Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural Effusion.
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efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural Effusions
Respiration, 2015Co-Authors: Xiaojuan Wang, Yuan Yang, Zhen Wang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Background: The differential diagnosis of pleural Effusions can present a considerable challenge, and the etiology of pleural Effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural Effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural Effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural Effusion in 342 (41.1%) patients, benign pleural Effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural Effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural Effusion.
Jun Zhang - One of the best experts on this subject based on the ideXlab platform.
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diagnostic value and safety of medical thoracoscopy in tuberculous pleural Effusion
Respiratory Medicine, 2015Co-Authors: Zhen Wang, Xiaojuan Wang, Yuan Yang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Abstract Background Differentiating tuberculous pleural Effusion from other lymphocytic pleural Effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural Effusion. Methods Between July 2005 and June 2014, patients with pleural Effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural Effusion were analyzed. Results During this 9-year study, 333 of 833 patients with pleural Effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. Conclusions Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural Effusion.
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efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural Effusions
Respiration, 2015Co-Authors: Xiaojuan Wang, Yuan Yang, Zhen Wang, Lili Xu, Yanbing Wu, Jun Zhang, Zhaohui TongAbstract:Background: The differential diagnosis of pleural Effusions can present a considerable challenge, and the etiology of pleural Effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural Effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural Effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural Effusion in 342 (41.1%) patients, benign pleural Effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural Effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural Effusion.
