胸腔积液中白细胞介素1β的变化及其临床意义

应用抗白细胞介素１β单克隆抗体建立酶联免疫吸附试验，动态观察了２８例细菌性胸膜炎和１３例肺癌患者胸腔积液中ＩＬ１β、ＩＬ１β自身抗体及含ＩＬ１β特异性免疫复合物含量的变化情况。提示两种病理变化过程中细胞因子的作用存在差异。     

白介素Ⅱ联合顺铂治疗恶性胸腔积液的临床研究

目的 :评价白介素 联合顺铂治疗恶性胸腔积液的疗效。方法 :4 4例恶性胸腔积液患者随机分为二组。结果 :在治疗后 6个月 ,B组缓解率明显高于 A组。结论 :白介素 联合顺铂治疗恶性胸腔积液的疗效明显高于单药     

Pleural haemorrhage in Henoch Schonlein purpura

Summary We describe a seven-year old boy with Henoch-Schonlein purpura who presented with extensive skin rash, arthritis, and persistent abdominal pain. He was found to have small intestinal submucosal and subserosal haemorrhage on exploratory laparatomy. He developed pleural haemorrhages in the course of the disease, which to our knowledge has not been reported before in this disease.     

Prognostic factors for pleural lymphoma patients.

Prognostic factors in 47 patients with pleural lymphocytic lymphoma developing in chronic tuberculous pyothorax were evaluated using Cox's proportional hazards model. There were 41 men and six women, aged 44-80 (median 61) years. Approximately 70% of the patients had localized disease in Stages I and II, and 30% advanced disease in Stages III and IV. Histologically, 27 patients had the diffuse large, immunoblastic type and 12 had others. In the other seven patients, histological subtyping of the lymphocytic lymphoma was impossible because of degenerative or necrotic changes in the histologic specimens. A diagnosis of lymphocytic lymphoma of B-cell type was made in one case using combined cytologic and surface maker findings on a cell suspension. In addition, immunologic and immunohistochemical studies revealed another 40 cases to be proven B-cell lymphomas. Poor performance status and elevated levels of BUN and GPT were significantly associated with shortened survival in a Cox's proportional hazards model. A poor performance status and high levels of serum BUN and GPT suggested a marked deterioration in a patient's condition. When compared with previous literature describing prognostic factors in patients with B-cell lymphomas and with lymphocytic lymphomas with unfavorable histologies or associated with long-standing inflammations, the only common prognostic factors was performance status. The significance of primary site in predicting survival from lymphocytic lymphoma is discussed.     

Pleuritis and pleural effusion as the initial presentation of systemic lupus erythematous in a 23-year-old woman

Systemic lupus erythematous (SLE) is a chronic inflammatory autoimmune disorder that primary affects women and may affect any organ system. Pleural inflammation is a common feature of SLE; however, as an initial presentation in SLE is rare. The author report the case of a 23-year-old woman with chest pain, dyspnea and without fever for 1 week. On physical examination, fine crackles were heard and vocal fremitus was decreased at the base of the left-side of lung. Patient had no symptoms/signs that can meet the SLE criteria; however, immunological workup showed positive response of ANA-speckle, anti-dsDNA, and anti-ENA in patient serum and pleural fluid. Lupus pleuritis with effusions was confirmed by the above investigation. A 1-month course of oral prednisolone-combined oral methrotreate was beneficial in relieving the pleuritis and pleural effusions.     

A decision tree for differentiating tuberculous from malignant pleural effusions

OBJECTIVE: To improve physicians' ability to discriminate tuberculous from malignant pleural effusions through a simple clinical algorithm that avoids pleural biopsy. DESIGN: We retrospectively compared the clinical and pleural fluid features of 238 adults with pleural effusion who satisfied diagnostic criteria for tuberculosis (n=64) or malignancy (n=174) at one academic center (derivation cohort). Then, we built a decision tree model to predict tuberculosis using the C4.5 algorithm. The model was validated with an independent sample set from another center that included 74 tuberculous and 293 malignant effusions (validation cohort). RESULTS: Among 12 potential predictor variables, the classification tree analysis selected four discriminant parameters (age>35 years, pleural fluid adenosine deaminase>38U/L, temperature>or=37.8 degrees C, and pleural fluid LDH>320U/L) from the derivation cohort. The generated flowchart had 92.2% sensitivity, 98.3% specificity, and an area under the ROC curve of 0.976 for diagnosing tuberculosis. The corresponding operating characteristics for the validation cohort were 85.1%, 96.9% and 0.958. CONCLUSIONS: Applying a decision tree analysis that contains simple clinical and laboratory data can help in the differential diagnosis of tuberculous and malignant pleural effusions.     

A case report of thoracic endometriosis – A rare cause of haemothorax

IntroductionThe presence of endometrial tissue in airways, pleura and lung parenchyma is called thoracic endometriosis syndrome (TES). It is a rare pathology, and typically consists of catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules. We report a case of a 36-year-old woman with thoracic endometriosis causing catamenial haemothorax.ConclusionsThe diagnosis of thoracic endometriosis is complicated and often delayed. TES should be suspected in a reproductive age woman with exacerbating symptoms during the menstruation.Treatment may be medical and surgical.     

Post-cardiac injury syndrome: an atypical case following percutaneous coronary intervention

Post-cardiac injury syndrome (PCIS) is a syndrome characterized by pericardial and/or pleural effusion, triggered by a cardiac injury, usually a myocardial infarction or cardiac surgery, rarely a minor cardiovascular percutaneous procedure. Nowadays, the post-cardiac injury syndrome, is regaining importance and interest as an emerging cause of pericarditis, especially in developed countries, due to a great and continuous increase in the number and complexity of percutaneous cardiologic procedures. The etiopathogenesis seems mediated by the immunitary system producing immune complexes, which deposit in the pericardium and pleura and trigger an inflammatory response. We present the atypical case of a 76-year-old man presenting with a hydro-pneumothorax, low-grade fever and elevated inflammation markers, after two complex percutaneous coronary interventions, executed 30 and 75 days prior. The clinical features of our case are consistent with the diagnostic criteria of PCIS: prior injury of the pericardium and/or myocardium, fever, leucocytosis, elevated inflammatory markers, remarkable steroid responsiveness and latency period. Only one element does not fit with this diagnosis and does not find any further explanation: the air accompanying the pleural effusion, determining a hydro-pneumothorax and requiring a pleural drainage catheter positioning.     

可调节式床上胸腔穿刺桌的研制与应用

目的 介绍可调节式床上胸腔穿刺桌的研制并观察其临床应用效果.方法 将胸腔穿刺患者100例,随机分为实验组和对照组各50例,实验组采用可调节式床上胸腔穿刺桌行胸腔穿刺术,对照组采用传统方法 行穿刺术,观察2组患者脉搏、呼吸、动脉血氧饱和度的变化,比较2组穿刺效果.结果 穿刺后2组患者脉搏、呼吸均增快,2组比较差异显著;动脉血氧饱和度下降,2组比较差异显著.实验组患者一次穿刺成功率、舒适度、满意度方面优于对照组,差异显著.结论 可调节式床上胸腔穿刺桌能减轻患者不适,提高穿刺成功率及患者满意度.