Pleural function and lymphatics

The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the tight mechanical coupling between the lung and the chest wall. The efficiency of the lung–chest wall coupling depends upon pleural liquid volume, which in turn reflects the balance between the filtration of fluid into and its egress out of the cavity. While filtration occurs through a single mechanism passively driving fluid from the interstitium of the parietal pleura into the cavity, several mechanisms may co‐operate to remove pleural fluid. Among these, the pleural lymphatic system emerges as the most important one in quantitative terms and the only one able to cope with variable pleural fluid volume and drainage requirements. In this review, we present a detailed account of the actual knowledge on: (a) the complex morphology of the pleural lymphatic system, (b) the mechanism supporting pleural lymph formation and propulsion, (c) the dependence of pleural lymphatic function upon local tissue mechanics and (d) the effect of lymphatic inefficiency in the development of clinically severe pleural and, more in general, respiratory pathologies.     

210例针刺胸膜活检分析

目的研究针刺胸膜活检在胸腔积液病因诊断中的价值和安全性。方法对2000年12月至2007年12月间诊断明确且做过1次以上胸膜活检的210例胸腔积液患者的临床资料进行回顾分析。结果210例胸腔积液中结核性胸膜炎102例，恶性胸膜炎60例，两者胸膜活检的阳性率分别为66．7％（68／102）和69．7％（60／86）。术后并发症主要为：气胸34．9％（105／301）、出血11．6％（35／301）、术后发热12-3％（37／301）、胸膜反应7．3％（22／301）、肿瘤细胞针道种植1．0％（3／301），未出现致命并发症。结论在结核性及恶性胸腔积液的诊断中，针刺胸膜活检是一种有效而又安全的手段，多次活检可提高确诊率。     

Apoptosis and extracellular matrix remodelling in human silicosis

AIMS: Silicosis is a chronic occupational disease caused by the inhalation of free crystalline silica particles which produce inflammation and tissue destruction followed by remodelling of the extracellular matrix. Apoptosis has been implicated in the development of the initial inflammation that triggers the remodelling process. Our aim was to elucidate the importance of Fas-ligand (Fas-L) in this disorder and to study the relationship between Fas-L and several other inflammatory and fibrotic remodelling markers. METHODS AND RESULTS: We analysed 23 lung biopsies from silicotic patients and five controls, quantifying Fas-L and Bcl-2 expression by inflammatory cells as well as mast cells and collagen and elastic fibres. We used immunohistochemistry and morphometry to evaluate the amount of Fas-L and Bcl-2. Our analysis revealed that the silicotic lung stage was significantly related to Fas-L, mast cell and extracellular matrix remodelling. Fas-L expression was inversely associated with mast cells, collagen/elastic deposition and the silicotic lung. CONCLUSION: Fas-L, mast cell staining and collagen/elastic fibre quantities in silicotic lungs are strongly related to silicosis progression.     

Pleural effusion cytology of embryonal rhabdomyosarcoma

This case report concerns an embryonal rhabdomyosarcoma of the testis in a 31-yr-old white male patient who underwent radical left orchiectomy, followed by combined irradiation and chemotherapy, and who 2 yr later presented with dyspnea at rest, nonproductive cough, and lower back pain for 1 wk. Chest radiographs demonstrated a bilateral pleural effusion and diffuse infiltrating lesion of the pleurae, mimicking a mesothelioma. The pleural fluid displayed noncohesive, malignant, small, round cells about 2–5 times larger than mature lymphocyes. They had large, darkly staining, pleomorphic nuclei and bubbly cytoplasm with poorly defined borders. The diagnosis of embryonal rhabdomyosarcoma was supported by a positive myosin immunostaining and ultrastructural findings of intracytoplasmic actin and myosin-type microfilaments. Our case is also notable in that the tumor was a pure rhabdomyosarcoma involving a testicular origin, and the patient is the oldest reported in the literature. Diagn. Cytopathol. 16:270–273, 1997. © 1997 Wiley-Liss, Inc.     

Lymphopenia in occupational pulmonary silicosis with or without autoimmune disease.

An increased prevalence of autoimmune diseases such as rheumatoid arthritis has been demonstrated in silica-exposed patients. The aim of this study was to determine the peripheral blood lymphocyte phenotype in a population of silicotic workers employed in the slate mines of the district. Silicosis was assessed in 58 patients according to the International Labor Office's criteria. Clinical and biological data including flow cytometric evaluation of the lymphocyte subsets were compared with those from 41 healthy volunteers. The silicotic patients had a higher prevalence of autoimmune diseases (6/58 versus 0/41: P < 0.05) and of elevated antinuclear antibody titres compared to the control group. A very significant decrease of total lymphocyte count (P < 0.001) involving B, T and Natural Killer cells was found in silicotic patients as compared with matched healthy volunteers. A significant increase in the percentage of activated T cells (12.3%) was observed in the silicotic group as compared to 6.5% in the control group (P = 5 x 10(-5)). Our results show that in silicotic patients, the absolute number of circulating lymphocytes is diminished with an increased proportion of activated T cells. Whether these findings could predispose to the development of autoimmune disorders is discussed.     

Serum levels of soluble Fas ligand in patients with silicosis

Certain patients with silicosis have been reported to exhibit immunological abnormalities such as the appearance of antinuclear antibodies and the occurrence of autoimmune diseases. Fas ligand (FasL) is a type II membrane protein which induces apoptosis by binding to its membrane receptor, Fas. FasL is converted to a soluble form by a metalloproteinase-like enzyme. We have already found serum soluble Fas (sFas) levels in silicosis patients as well as in patients with systemic lupus erythematosus (SLE) to be significantly higher than those in healthy volunteers. To examine further the role of the Fas/FasL system in silica-induced immunological abnormalities, we investigated serum soluble FasL (sFasL) levels in silicosis patients with no clinical symptoms of autoimmune diseases, using ELISA for sFasL. Although the serum sFasL levels in patients with SLE were significantly higher than those in healthy volunteers and showed a slight positive correlation with serum sFas levels, those in silicosis patients exhibited no significant difference from those in healthy volunteers, and there was no correlation with serum sFas levels. However, sFasL levels were elevated in silicosis patients with slight dyspnoea or normal PCO2 among various clinical parameters of silicosis. It may be speculated that the immunological disturbances presented by the abnormalities of apoptosis-related molecules in silicosis patients do not occur with a similar degree of respiratory involvement. Further studies are required to clarify which kinds of factors are involved in silicosis patients who exhibit immunological abnormalities.     

Pleural effusion: a rare complication of hepatitis A

Hepatitis A (HAV) infection, which is the most common form of hepatitis in the paediatric age group and which sometimes has a fulminant course, is endemic in Turkey, constituting one of the country's important health problems. Pleural effusion also represents a rare benign complication of acute HAV infections. We describe here a case of Hepatitis A who developed pleural effusion.     

Detection, epitope-mapping and function of anti-Fas autoantibody in patients with silicosis

Dysregulation of apoptosis through the Fas-Fas ligand pathway is associated with the onset of autoimmune disease. Since autoantibodies directed against unknown antigens are present in the sera of these patients, sera samples were examined for the presence of autoantibodies directed against the Fas molecule. Using Western blotting and a ProteinChip analysis, autoantibodies against Fas were detected in patients with silicosis, systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), and weakly detected in healthy individuals. Using epitope mapping employing 12-amino-acid polypeptides with the SPOTs system, a minimum of four epitopes and a maximum of 10 epitopes were found. Several amino acid residues involved in binding FasL, such as C66, R87, L90, E93 and H126, were presented within the epitopes. Serum containing a large amount of anti-Fas autoantibody from silicosis patients inhibited the growth of a Fas-expressing human cell line, but did not inhibit the growth of a low Fas-expresser nor a Fas-expresser in which the Fas gene had been silenced by small interference RNA. All epitopes in the intracellular region of Fas were located in the death domain. The possible roles of anti-Fas autoantibody detected in healthy volunteers and patients with silicosis or autoimmune diseases are discussed here.     

Argyria: Microanalytic—Morphologic Correlation Using Paraffin-Embedded Tissue

Scanning electron microscopes, which have energy dispersive spectroscopy (x-ray microanalysis) capability, can provide accurate identification of the composition of inorganic deposits in tissue. We report a case of florid argyria in which the same deparaffinized 4-μm sections were sequentially examined by light microscopy, scanning electron microscopy, backscattered electron imaging, and x-ray microanalysis to confirm the clinical impression of argyria. We recommend the use of x-ray microanalysis of paraffin-embedded tissue as a simple, rapid and inexpensive means of precise identification of inorganic deposits of heavy elements in tissue sections.     

肺栓塞合并胸腔积液36例分析

目的提高对肺栓塞的认识，减少其误诊率。方法回顾性分析36例肺栓塞合并胸腔积液病例。结果94例肺栓塞中合并胸腔积液36例，占38％，其中少量积液30例，中等量积液4例，大量积液2例。双侧积液21例，右侧积液9例，左侧积液6例，心包积液4例。6例中、大量积液胸水检查，均为渗出性，其中4例为血性（2例为肺癌）。36例中D-二聚体升高35例；螺旋CT36例均有肺动脉栓塞改变，其中2例合并肺不张．4例合并心包积液。15例作肺通气灌注扫描均有阳性表现。结论肺栓塞是胸腔积液的常见病因之一，临床遇到不明原因的胸腔积液特别是血性积液，要考虑肺栓塞的可能，及时筛查D-二聚体，阳性者高度怀疑肺栓塞．再行肺通气灌注扫描、螺旋CT等检查进一步明确诊断。     

Pleural metastasis from auricular melanoma: A brief report

Primary auricular melanoma is rarely reported. Approximately, it accounts for 1% to 4% of all cutaneous melanoma. Early literature suggested that melanoma of the ear is more aggressive than other melanomas, with a propensity for spreading to both regional lymph nodes and distant sites. Here, we present a case of cytological pleural metastasis from auricular melanoma in a 43‐year‐old woman. Immunohistochemical staining showed that the tumors cells were positive for S‐100 protein and Melan‐A. The mutation of the v‐raf murine sarcoma viral oncogene homolog B (BRAF)^V600E was demonstrated on Sanger sequencing. To our knowledge, this is the first report describing the cytomorphology of metastatic auricular melanoma in pleural effusion.     

红霉素胸膜粘连术对难治性自发性气胸的治疗价值

目的观察红霉素胸膜粘连术对难治性自发性气胸的治疗价值。方法经胸腔闭式引流管注人红霉素到胸膜腔治疗难治性自发性气胸28例为治疗组，以同期28例难治性自发性气胸经胸腔闭式引流治疗为对照组。结果以红霉素为硬化剂的胸膜粘连术治疗方法的治疗组28例复发3例，复发率约为10％。对照组28例复发11例，复发率约为39％，两组间差异有统计学意义（P=0．014）。结论胸腔引流管注人红霉素治疗难治性自发性气胸是简便易行，安全、费用低的一种有效方法，具有一定的治疗价值，可在基层医院推广。     

AM、CYFRA21-1、NSE和CEA联合检测对恶性与结核性胸腔积液的鉴别诊断价值

用RIA检测了52例(男32例, 女20例)结核性胸腔积液组和74例(男49例,女25例)恶性胸腔积液组的肾上腺髓质素(AM)、CYFRA21-1、NSE和CEA水平,结果表明: 恶性胸腔积液组四项肿瘤标志物含量均显著高于结核性胸腔积液组, 四项联合检测可进一步提高诊断敏感性和准确性至90.5%和92.9%, 有显著性差异(P＜0.01).结论: 胸腔积液AM、 CYFRA21-1、NSE和CEA联合检测对鉴别恶性与结核性胸腔积液有实用价值, 可显著提高恶性胸腔积液的阳性诊断率.     

Diagnostic Value and Prognostic Significance of Pleural C-Reactive Protein in Lung Cancer Patients with Malignant Pleural Effusions

Purpose

C-reactive protein (CRP) has been implicated in various inflammatory and advanced malignant states. Increased serum CRP (s-CRP) levels have been shown to be associated with independent prognostic factors for survival in patients with advanced lung cancer. However, only few studies have focused on the role of CRP in pleural effusions. This study aimed to evaluate the diagnostic and prognostic value of pleural CRP (p-CRP) in lung cancer patients with malignant pleural effusion (MPE).

Materials and Methods

Pleural effusion (PE) samples were collected from patients with MPE (68 lung cancers; 12 extrathoracic tumors), and from 68 patients with various benign conditions (31 with pneumonia; 37 with tuberculosis). Concentrations of p- and s-CRP were measured by enzyme-linked immunosorbent assay. CRP level in pleural fluid and its association with survival were examined.

Results

p-CRP levels correlated with s-CRP levels (r=0.82, p<0.0001). For the differential diagnosis of MPE and benign PE, the area under the receiver operating characteristic curve was greater for p-CRP (0.86) than for s-CRP (0.77). High p-CRP expression significantly correlated with shorter overall survival (p=0.006). P-CRP was independent prognostic factor significantly associated with overall survival on multivariated analysis (p=0.0001). The relative risk of death for lung cancer patients with high p-CRP levels was 3.909 (95% confidence interval, 2.000-7.639).

Conclusion

P-CRP is superior to s-CRP in determining pleural fluid etiology. Quantitative measurement of p-CRP might be a useful complementary diagnostic and prognostic test for lung cancer patients with MPE.     

The Reserpinized Rat in the Study of Cystic Fibrosis: X-ray Microanalysis of Submandibular Gland and Pancreas

The chronically reserpinized rat has been suggested as an animal model for cystic fibrosis. X-ray microanalysis of thick and thin cryosections was carried out to assess elemental redistribution in the submandibular glands and the pancreas of reserpinized rats at the cellular and subcellular level. In the submandibular gland of reserpinized rats, calcium and magnesium concentrations were significantly elevated. Mucus globules, secretory granules, and endoplasmic reticulum were the primary sites of the localization of excess calcium and magnesium. A significant potassium loss from the gland had occurred, particularly from the serous cells. Electron microscopy of conventionally prepared tissue showed marked swelling of the endoplasmic reticulum, especially in mucous cells.

The elemental changes in the pancreatic acinar cells of reserpinized rats were reminiscent of elemental redistribution connected with cell death: increased levels of sodium, chlorine, and calcium and decreased levels of magnesium and potassium. Ultrastructural changes included swelling of the endoplasmic reticulum and obstruction of the acinar lumen. It is concluded that elemental redistribution in chronically reserpinized rats presents interesting parallels with cystic fibrosis.     

The Reserpinized Rat in the Study of Cystic Fibrosis: X-ray Microanalysis of Submandibular Gland and Pancreas

The chronically reserpinized rat has been suggested as an animal model for cystic fibrosis. X-ray microanalysis of thick and thin cryosections was carried out to assess elemental redistribution in the submandibular glands and the pancreas of reserpinized rats at the cellular and subcellular level. In the submandibular gland of reserpinized rats, calcium and magnesium concentrations were significantly elevated. Mucus globules, secretory granules, and endoplasmic reticulum were the primary sites of the localization of excess calcium and magnesium. A significant potassium loss from the gland had occurred, particularly from the serous cells. Electron microscopy of conventionally prepared tissue showed marked swelling of the endoplasmic reticulum, especially in mucous cells.

The elemental changes in the pancreatic acinar cells of reserpinized rats were reminiscent of elemental redistribution connected with cell death: increased levels of sodium, chlorine, and calcium and decreased levels of magnesium and potassium. Ultrastructural changes included swelling of the endoplasmic reticulum and obstruction of the acinar lumen. It is concluded that elemental redistribution in chronically reserpinized rats presents interesting parallels with cystic fibrosis.     

N-乙酰基-丝氨酰-天冬氨酰-赖氨酰-脯氨酸对基质金属蛋白酶-1和基质金属蛋白酶组织抑制因子-1的调节在大鼠矽肺纤维化形成中的作用

目的:探讨N-乙酰基-丝氨酰-天冬氨酰-赖氨酰-脯氨酸(AcSDKP)对大鼠肺内基质金属蛋白酶-1(MMP-1)和基质金属蛋白酶组织抑制因子-1(TIMP-1)表达的调节在拮抗矽肺纤维化形成过程中的作用.方法:气管内灌注染尘法制作大鼠矽肺模型,将含有AcSDKP的微量药物释放泵埋入腹腔.实验动物随机分为矽肺模型对照4周组,矽肺模型对照8周组,矽肺模型4周组,矽肺模型8周组,抗纤维化治疗组及预防治疗组.H-E染色和免疫组织化学显色对矽肺纤维化病变和MMP-1和TIMP-1在肺组织内的表达进行形态学观察;免疫印迹法对肺内MMP-1和TIMP-1酶蛋白表达进行检测.结果:与模型对照组比较,矽肺大鼠肺内MMP-1和TIMP-1表达增强.与矽肺模型组比较,AcSDKP能够上调矽肺大鼠肺内MMP-1的表达,下调TIMP-1的表达,使MMP-1/TIMP-1的比值升高.结论:AcSDKP能够促进矽肺大鼠肺内MMP-1的表达,抑制TIMP-1的表达,从而加速了细胞外基质(包括胶原)的降解,这可能与AcSDKP抗矽肺纤维化的作用有关.