Pleural effusion: an "acoustic window" for sonography of pleural metastases.

We report the sonographic findings in 32 patients with malignant disease associated with pleural effusions diagnosed by chest roentgenograms. No tumor lesions were seen in any case on X-ray films. Thoracic sonography, however, detected previously undocumented metastatic disease with diaphragmatic (N = 19), parietal (N = 8), visceral (N = 2) or combined (N = 3) pleural involvement. Additionally, a distinction could be made between nodular lesions (N = 19), sheet-like tumor masses (N = 10), and combined (N = 3) tumor spread. In all cases thoracentesis was performed. Cytology showed malignant cells in 28 patients. Pleural metastasis was histologically confirmed by ultrasound-guided fine needle biopsy in 2 cases. The present study demonstrates the value of scrutinized thoracic sonography in patients with pleural effusion for the detection of pleural metastases.     

Role of biochemical tests in the diagnosis of exudative pleural effusions

OBJECTIVES: To examine the diagnostic utility of pleural adenosine deaminase (PADA), pleural lactate dehydrogenase (PLDH), and several other biochemical tests in bronchogenic carcinoma and malignant mesothelioma, and to compare biochemical characteristics of their fluid with nonmalignant pleural effusions. DESIGN AND METHODS: This study consisted of 226 patients diagnosed with malignant (75), tuberculous (65), and parapneumonic pleural effusions (86). We examined the following biochemical parameters in the pleural fluid and serum: adenosine deaminase, lactate dehydrogenase, glucose level, protein level, pleural fluid/serum ADA ratio (P/S ADA), P/S LDH ratio, and P/S protein ratio. RESULTS: Parapneumonic pleural effusions had a significantly higher level of PLDH and of P/S LDH than malignant and tuberculous pleural effusions (P = 0.000), and malignant pleural effusions had a higher level of PLDH than tuberculous pleural effusions. Tuberculous and parapneumonic effusions had significantly higher levels of PADA than those of malignant effusions (P = 0.000). When the 54 patients having bronchogenic carcinoma were compared to the remaining 21 mesothelioma patients, the former had a lower median level of PADA (P = 0.001) with a higher level of PLDH (P = 0.05). CONCLUSION: Our results show that high pleural LDH and low PADA levels are suggestive of pleural effusion due to bronchogenic carcinoma, whereas high levels of PADA alone can be indicative of tuberculous pleural effusion and high levels of both markers can show complicated parapneumonic effusions or empyema.     

恶性胸腔积液的CT诊断

目的：探讨恶性胸腔积液的CT表现特点。及CT在恶性胸腔积液诊断中的应用价值。材料与方法：分析56例经手术,病理,胸水等证实的恶性胸腔积液的CT征象,结果：恶性胸腔积液的特征性CT表现为胸膜的明显增厚,其形态改变有一定特点,可分为四型,但CT对无或仅有轻度胸膜增厚的恶性胸腔积液的诊断仍较困难。结论：CT是诊断恶性胸腔积液的重要检查方法之一,可清楚显示胸膜增厚的范围及程度,后者是鉴别诊断中有重要价值的CT征象。     

1例恶性胸膜间皮瘤的循证治疗

目的为1例确诊的恶性胸膜间皮瘤患者制定循证化疗方案。方法在充分评估患者病情的基础上，根据PICO原则，提出临床问题并转换成便于检索的形式，检索Cochrane图书馆（2007年第1期）、PubMed（1966～2007．2）和EMbase（1974年～2007年2月）。结果共检索出治疗恶性胸膜间皮瘤的随机对照试验5篇、系统评价4篇和卫生经济学评价1篇。根据检索结果，并结合患者病情和意愿，为患者制定出雷替曲塞联合顺铂的化疗方案，共进行5个周期的化疗，同时给予胸腔穿刺抽液及其它对症治疗。经过4月的随访证实，该方案适合患者。结论采用循证医学的方法为确诊的恶性胸膜间皮瘤患者制定最佳化疗方案可有效提高治疗效果。     

Tuberculous pleural effusions: ultrasonic diagnosis.

Twenty patients with tuberculous pleural effusions were studied with ultrasonography. In 18 patients, ultrasonography demonstrated regular pleural thickening which was less than 1 cm except in 1 case. In 4 cases there were a few pleural nodules, whereas in 2 cases the pleural surface showed small nodularity. The latter finding may be diagnostic for a tuberculous etiology. Eighteen patients had multiple, delicate, mobile septations in the effusions, and a lattice-like appearance had formed in 6 cases. Computed tomography was obtained in 7 cases, and pleural thickening was demonstrated in 6 of them. Ultrasonography is a useful imaging modality in the diagnosis of tuberculous pleurisy.     

Intrapleural mitoxantrone for the palliative treatment of malignant pleural effusions

A group of 21 patients with malignant pleural effusions were treated with the instillation of 40 mg mitoxantrone intrapleurally, after complete fluid drainage. There was a 100% complete response rate with no toxic effects (0%). The mean survival of the patients was 57.1 weeks.     

Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient). METHODS: From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity. RESULTS: There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests. CONCLUSIONS: The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.     

胸膜活检对胸腔积液病因诊断的临床价值

目的:探讨胸膜活检对胸腔积液病因诊断的价值。方法:对268例胸腔积液患者行经胸壁胸膜活检术。结果:268例患者共行胸膜活检289次,二次及以上活检者19例,获取胸膜组织244例,穿刺成功率91%,经病理检查有18例为正常胸膜组织,阳性诊断者为226例,阳性率92.6%(226/244),其病理诊断为结核104例(46%)、肿瘤54例(23.9%)、慢性炎症68例(30.1%);发生并发症者19例(6.6%),全部为气胸,肺压缩均小于30%,未做特殊处理数日后自行吸收。结论:从本组资料可以看出,经胸壁胸膜活检术对于胸腔积液的病因诊断具有非常好的效果,相比胸水涂片或病理检查具有更高的阳性率。因此经胸壁胸膜活检术由于它的简单、安全、高效等特点,目前在胸腔积液病因诊断方面仍是一项重要的手段。     

胸膜活检对胸腔积液的病因诊断价值

目的：探讨胸膜活检对胸腔积液病因诊断的价值。方法：对127例胸腔积液患者行首次胸膜活检术。结果：127例患者获取胸膜组织125例,穿刺成功率98.4%,经病理检查有41例为正常胸膜组织,特异性病理诊断84例,病理诊断阳性率（67.2%）。恶性胸腔积液胸膜活检阳性38例（45.2%）,结核性胸腔积液胸膜活检阳性31例（36.9%）,非特异性炎15例（17.9%）。38例恶性肿瘤经免疫组织化学和特殊染色分类,腺癌27例,小细胞肺癌2例,鳞癌2例,恶性间皮瘤2例,转移癌3例,淋巴瘤1例,未分化癌1例。发生并发症者4例（3.1%）,全部为气胸,肺压缩均小于15%,未做特殊处理数日后自行吸收。结论：胸膜活检是一项安全、简单、有效的胸膜疾病的重要的内科确诊手段。     

康莱特注射液联合顺铂腔内注射治疗恶性胸腔积液的疗效观察

目的:观察康莱特注射液联合顺铂胸腔内注射治疗恶性胸腔积液的疗效。方法:46例恶性胸腔积液患者随机分为两组,康莱特联合顺铂组22例,顺铂单药组24例。分别于胸腔穿刺引流术后胸腔内注射药物,观察其疗效和副反应。结果:康莱特联合顺铂组有效率86.4%,顺铂单药组62.5%,两组间差异有统计学意义(P<0.01)。两组患者治疗后毒副反应无明显差异。结论:康莱特联合顺铂腔内注射是治疗恶性胸腔积液的有效方法。     

阴阳模全胸膜腔照射治疗晚期肺癌伴恶性胸水的方法及疗效观察

目的 :用阴阳模式 6MvX线和电子线混合照射治疗恶性肿瘤胸膜转移伴恶性胸水 ,观察患者对该方法的耐受性 ,放射性肺炎的发生率和胸水控制及肿瘤消退的疗效 ,统计患者的生存率。方法 :本科自 2 0 0 1年 5月～ 2 0 0 4年 4月共使用阴阳模照射治疗肺癌伴恶性胸水 4 2例 ,患者胸水均被引流 ,胸水细胞学检查均找到恶性细胞。 6MvX线野包括全胸膜腔、原发灶、纵膈转移淋巴结 ,中央铅块屏蔽 ,用电子束照射。计算中平面胸膜受量 10 0 %等剂量线为 2Gy常规照射 15次 ,可见肿瘤局部加量2 0Gy/ 10Fx。中平面约 2 / 3肺组织受量 <5 0 %。患者在照射前后接受 3～ 6个疗程化疗。用Kaplan -Meier法计算胸水控制率和患者生存率。结果 :治疗结束后胸水即时疗效表现为完全控制 15例 ,部分控制 2 7例 ,6、12、18个月的胸水控制率分别为86 %、71%、5 1% ,患者 6、12、18个月生存率分别为 93%、80 %、5 7%。全组中位生存期为 16个月。治疗前后心、肝、肾功能无明显变化 ,照射后血象较前下降 ,急性食管炎 (Ⅰ～Ⅱ级 ) 17例 ,后期胸膜明显增厚伴纤维化 5例。未发生急性放射性肺炎。结论 :阴阳模式 6MvX线和电子线混合照射全胸膜腔能有效地抑制胸膜上恶性肿瘤 ,有较好的胸水控制疗效 ,临床使用安全 ,提高恶性胸水患者的生存率和生     

甘露聚糖肽联合顺铂治疗恶性胸腔积液的系统评价

目的采用循证医学的方法评价甘露聚糖肽联合顺铂对比单用顺铂治疗恶性胸腔积液的有效性和安全性。方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库,收集甘露聚糖肽联合顺铂对比单用顺铂治疗恶性胸腔积液的随机对照试验,检索时间为各数据库建库至2011年3月。对文献进行质量评价,用RevMan 5.0软件对数据进行Meta分析。结果共纳入6项研究,所有文献质量均为C级。共收入388例患者,Meta分析结果显示甘露聚糖肽联合顺铂组与单用顺铂组相比,总有效率前者高于后者,差异有统计学意义（P〈0.05）;消化道不良反应发生率两组组间差异无统计学意义（P=0.05）;骨髓抑制发生率前者低于后者,差异有统计学意义（P〈0.05）;Karnofsky评分提高率前者高于后者,差异有统计学意义（P〈0.05）。结论系统评价表明,甘露聚糖肽联合顺铂治疗恶性胸腔积液的疗效优于单用顺铂的方案。     

免、化、热三联法治疗恶性胸水的临床护理

目的探讨免、化、热三联法综合治疗恶性胸腔积渡的护理对策。方法37例恶性胸水惠者采用经胸腔内置入Arrow，管先行持续胸水引流，待胸水引流满意后，胸腔内注入高聚生（HASL）5000^U＋顺铂（CDDP）60mg，然后联合胸部容式射频热疗。护理方面，术前强调心理护理：三联法治疗前作好一般准备；治疗期间强调医护配合和密切观察患者的不适反应；术后注意加强胸腔Arrow管的护理，协助医生作好不良反应的观察和处理。结果总有效率为88．9％（24／27），临床症状缓解率88．9％（24／27），20例患者治疗后KPS评分明显提高（≥20），受益率70．1％（20／27）。发热是主要的毒副反应。结论经皮穿刺胸腔置管引流、注入免疫和化疗制剂并胸部射频热疗三联法治疗恶性胸水期间，加强临床护理是综合治疗成功的基础和关键。     

以胸腔积液起病的急性髓细胞白血病误诊原因分析

目的探讨急性髓细胞白血病(acute myelogenous leukemia,AML)的发病特点,提高对本病的认识。方法对1例以胸腔积液起病的AML患者的临床资料进行回顾分析并复习相关文献。结果患者因咳嗽、喘息伴左颈部肿痛入院,病初在外院行X线胸片检查发现胸腔积液,行CT检查见颈部及纵隔淋巴结增大,先后按肺部感染、结核性胸膜炎治疗无效,病程1个月左右双侧颈部迅速肿大、呼吸困难,多专科会诊,最终经骨髓穿刺细胞学检查及免疫组织化学染色检查确诊为AML。结论 AML浸润胸膜时可能以大量胸腔积液起病,浸润淋巴结可表现淋巴结增大,对此类病人要考虑到白血病的可能,避免误诊。     

Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions

Goals of work The goal of the study was to evaluate the safety and efficacy of bedside pleurodesis with doxycycline using a short-term indwelling chest catheter for the palliative treatment of malignant effusions.Materials and methods A prospective study of 36 rapid pleurodesis procedures in 34 patients with malignant pleural effusions was conducted over a 5-year period in a university hospital. A 12F chest catheter placement was facilitated utilizing the Seldinger percutaneous entry technique. Patients received 500 mg of intrapleural doxycycline combined in half of the cases with mepivacaine. We assessed success or failure of pleurodesis in addition to the frequency of complications and survival.Main results Chest tubes were removed within 24 h in 69% and within 48 h in 94% of the patients. Complete success of pleurodesis was achieved in 17 (55%), partial success in eight (26%), and failure in six (19%) out of 31 evaluative procedures. Thus, the overall success rate of pleurodesis was 81%. Toxicity was mild and included pain (36%), fever (8%), and pneumothorax (6%). The median survival was 105 days. There was no relationship between instillation of intrapleural anesthetics and development of pain.Conclusions Rapid pleurodesis with doxycycline, which can be accomplished within 24 to 48 h, is a valid option for the symptomatic treatment of malignant effusions. This technique can be used as a first-line procedure in the majority of cases, particularly if thoracoscopic facilities are not available.     

水通道蛋白1基因敲除对胸腔液体转运的影响

目的:探讨水通道蛋白1在小鼠胸腔液体转运的作用。方法:实验小鼠分为野生型组和基因敲除型组,每组基因型各分为高渗组和低渗组。小鼠吸入麻醉后,胸膜腔内分别注入高渗或等渗液体,处理组液体中含特布他林100μmol·L-1或阿米吡嗪200μmol·L-1。在不同时间收集胸腔液体,测量渗透压或体积。结果:胸膜腔内注入500mOsm液体后,在1,2和5min时收集胸腔液体测渗透压,野生型组中渗透压均明显高于基因敲除组(P<0.01)。胸腔内注入等渗液体后,在30,60和90min时收集胸腔液体测量体积,野生型组和基因敲除型组间无明显差异(P>0.05)。特布他林增加高渗和等渗液体胸腔转运(P<0.05),不受水通道蛋白1敲除的影响。阿米吡嗪抑制高渗和等渗液体胸腔转运(P<0.05),也不受水通道蛋白1敲除的影响。结论:水通道蛋白1促进渗透压引起的小鼠胸腔液体转运,对胸腔等渗液体清除无影响。钠通道影响胸腔高渗和等渗液体转运,水通道蛋白1基因敲除不影响钠通道的这种作用。     

Intracavitary Chemotherapy and Effect of Enhanced Sensitivity Researchand Nursing of Methylene Blue to Malignant Pleural Effusion

Ａｃｃｏｒｄｉｎｇｔｏｔｈｅｒｅｐｏｒｔｏｆｒｅｆｅｒｅｎｃｅ ,ｍｅｔｈｙｌｅｎｅｂｌｕｅｈａｄｋｉｌｌｉｎｇｅｆｆｅｃｔｔｏｐｅｒｓｏｎ‘ｓｅｘｔｒａｃｅｌｌｏｆｌｕｎｇｃａｎｃｅｒ ,ｐｒｏｌｉｆｅｒａｔｉｏｎｉｎｈｉｂｉｔｉｎｇｅｆｆｅｃｔａｎｄｈａｄｅｆｆｅｃｔｏｆｅｎｈａｎｃｅｄｓｅｎｓｉｔｉｖｉｔｙａｎｄｒｅｄｕｃｅｄ ｐｏｉｓｏｎ .Ｂｕｔｉｔｗａｓｌｉｔｔｌｅｒｅｐｏｒｔｅｄｏｎｉｔｓｉｎｔｒａｃｅｌｌｒｅｓｅａｒｃｈｉｎｃｌｉｎｉｃ .Ｉｎｏｒ ｄｅｒｔｏｐｒｏｂｅｔｈｅｐｒａｃｔｉｃ…     

雷替曲塞联合顺铂化疗恶性胸膜间皮瘤的系统评价

目的系统评价雷替曲塞联合顺铂与其他化疗方案化疗比较,治疗恶性胸膜间皮瘤的有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、EMbase和中国生物医学文献光盘数据库,纳入雷替曲塞联合顺铂与其他化疗方案比较治疗恶性胸膜间皮瘤的随机和半随机试验,检索时间截至2007年3月前。按Cochrane系统评价方法,评价纳入研究的方法学质量,并提取有效数据进行分析。结果仅纳入1个包括250例患者的随机对照试验。雷替曲塞联合顺铂方案与单用顺铂比较能够提高恶性胸膜间皮瘤患者的中位生存期(11.4个月vs8.8个月,P=0.048),且发生3～4级不良反应率与单用顺铂化疗相当。结论目前证据表明,雷替曲塞联合顺铂方案能纳入1个随机对照试验,共250例。提高肿瘤功能状态较好的恶性胸膜间皮瘤患者的生存时间,且不良反应发生率低,但仍需更多临床试验证实其疗效。