Echocardiographic observation of ventricular volume changes and swinging septal position in massive pericardial effusion

Swinging interventricular septal position and ventricular volume changes associated with respiration were studied in a patient with massive uremic pericardial effusion and pulsus paradoxus. Inspiration was regularly associated with a posterior swinging septal position which dramatically increased right ventricular (RV) volume with a lesser change in left ventricular (LV) volume. Expiration was consistently accompanied by an anterior swing of septal position which nearly obliterated the RV with slight enlargement of the LV. The above changes produced a pendulum-like motion of the septal position as the patient breathed. This may reflect the ventricular volume changes that accompany respiration in severe pericardial effusion associated with pulsus paradoxus.     

An unusual cause of pleural effusion, urinothorax in a child with urinary stone disease

The association of obstructive uropathy with ascites has been known since 1863 and with pleural effusion since 1954. Urinothorax is a rare complication of blunt renal trauma, ureteral instrumentation or ureteral surgery. Leakage from the urinary tract may cause urinoma, retroperitoneal collection of fluid, which can lead to urinothorax. This case report describes a child with a massive right-sided pleural effusion that was caused by same-sided renal calculi. The effusion disappeared within a few days after adequate urinary drainage had been established.     

Alteration of pemetrexed excretion in the presence of acute renal failure and effusions: presentation of a case and review of the literature

Pemetrexed is a multitargeted antifolate approved by the Food and Drug Administration for patients with mesothelioma and non small cell lung cancer. As this agent is almost exclusively cleared by renal excretion, trials leading to its approval were conducted in patients with normal renal function. However, this cycle active agent often is administered with cisplatin to patients who may have pleural effusions and ascites. As a result, the potential for drug accumulation in effusions and for accompanying renal insufficiency is real. Recommendations for the management of pemetrexed toxicity in the presence of renal failure have not been established. A case of treatment-related acute renal failure following chemotherapy with cisplatin and pemetrexed in a patient with advanced mesothelioma and ascites is presented. Pharmacologic studies in this patient revealed persistent pemetrexed levels in ascites and plasma. This is the first time that significant accumulation of pemetrexed in ascetic fluid has been reported in the literature. Treatment with leucovorin, folate, and continuous veno-venous hemodialysis was initiated. Thymidine and carboxypeptidase were not available. Dialysis was unsuccessful in removing pemetrexed. Theoretical and practical approaches to management of similar cases are presented.     

Effusion cytology in burkitt's lymphoma

The American form of Burkitt's lymphoma is a high-grade malignancy which usually involves the abdomen in children and young adults. There is only a limited literature which describes the cytologic features of Burkitt's lymphoma in serous effusions. We present three children with Burkitt's lymphoma initially diagnosed by effusion cytology. the first patient, an 11-yr-old boy, presented with bilateral pleural effusions, ascites, and abdominal masses and had diagnostic pleural fluid cytology without tissue confirmation (ultrastructural examination was performed on the effusion specimen). He died 7 months after the initial diagnosis. the second patient, a 9-yr-old boy, presented with ascites and abdominal masses and had diagnostic peritoneal fluid cytology with a subsequent confirmatory chest wall biopsy. the third patient, a 16-yr-old girl, presented with a 2-month history of irregular menses, a large pelvic mass, lymphadenopathy, and liver masses. Although an ovarian malignancy was clinically suspected, cytologic examination of her peritoneal fluid revealed Burkitt's lymphoma. Surgical exploration revealed involvement of her right ovary, cecum, and terminal ileum. the second and third patients are currently alive with no apparent disease following chemotherapy. in all three patients, effusion cytology revealed Burkitt's lymphoma, characterized by a uniform population of noncohesive lymphoid cells with noncleaved nuclei, prominent multiple nucleoli, and scanty-to-moderate basophilic cytoplasm. Cytoplasmic and/or nuclear vacuoles were also seen, more prominent in Diff-Quik—stained, air-dried smears. These cases demonstrate the importance of recognizing the cytologic features of Burkitt's lymphoma, as serous fluid may be the initial diagnostic specimen.     

Comparative assessment of DNA analysis in effusions by lmage analysis and flow cytometry

Cytologic evaluation of body cavity fluids is useful to detect malignancy within the pleural and peritoneal spaces. A definitive diagnosis cannot always be made on cytologic evaluation alone. As malignant processes may show abnormal DNA content, DNA analysis of effusions may be useful. Therefore, we determined the DNA content of 37 effusions by flow cytometry (FC) and image analysis (IA) using the CAS 200. Of the 37 fluids evaluated, 18 were cytologically malignant, 15 benign, and four atypical. Overall, 22 fluids (60%) showed concordance between FC and IA. None of the benign fluids were aneuploid. All showed diploid histograms or diploidy with increased proliferating cells. Three of four atypical fluids had increased proliferating cells by either FC or IA, whereas one was diploid by both methods. Aneuploidy was detected in 13 malignant fluids: five were aneuploid by both methods and eight by only one method. IA identified aneuploidy in five of those eight cases, while three were identified by FC. Three of the cytologically malignant fluids were diploid by both methods, and two showed increased proliferating cells by IA and diploidy by FC. The specificity of both methods was 100%. However, the sensitivity of identifying a malignant fluid by aneuploidy is low, 44% for FC and 55% for IA. IA appears to identify small aneuploid populations more frequently than FC. The detection of aneuploidy in effusions is highly suggestive of malignancy, and the combination of both techniques gives the highest detection rate (72%). However, neither are as sensitive as traditional cytologic evaluation with the occasional use of additional histochemical stains. © 1994 Wiley-Liss, Inc.     

IFN-γ、VEGF联合检测在结核性胸腔积液和恶性胸腔积液鉴别诊断中的价值

目的探讨γ-干扰素(IFN-γ)、血管内皮生长因子(VEGF)联合检测在结核性胸腔积液(胸液)和恶性胸液鉴别诊断中的价值。方法以2004年3月—2005年5月住院的87例胸腔积液患者为研究对象,其中结核性胸液45例,恶性胸液42例,应用酶速率法检测胸液中腺苷酸脱氨酶(ADA)的活性,应用ELISA法检测IFN-γ、癌胚抗原(CEA)和VEGF的浓度。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算上述指标及VEGF/IFN-γ比值的诊断敏感性、特异性和准确性。结果结核性胸液组ADA和IFN-γ含量高于恶性胸液组,有显著性差异(P<0.01);恶性胸液组CEA、VEGF含量和VEGF/IFN-γ比值高于结核性胸液组,有显著性差异(P<0.01)。IFN-γ对结核性胸液诊断的敏感性和特异性高于ADA;VEGF/IFN-γ比值对恶性胸液诊断的敏感性和特异性高于CEA和VEGF。结论IFN-γ和VEGF/IFN-γ比值可以作为临床上鉴别结核性胸液和恶性胸液的有效指标。     

周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素

目的探讨周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素.方法周围型肺癌86例,按有无胸膜凹陷征分为实验组(34例)和对照组(52例),并分析其间质情况;然后对7个变量(瘤内纤维化、肿瘤-胸壁距离、组织学类型、肿瘤大小、分化程度、淋巴结转移及患者性别)分别进行单因素及Logistic回归模型多因素相关分析.结果(1)胶原纤维为瘤内主要间质纤维,实验组高于对照组(t=3.074,P＜0.01);实验组Ⅰ型胶原含量高于对照组(t=2.896,P＜0.01),成纤维母细胞百分含量高于对照组(χ2=10.785,P＜0.05).(2)实验组瘤内纤维化程度高于对照组(t=3.074,P＜0.01),瘤-壁距离及瘤灶直径均小于对照组(t=5.444,2.874,P＜0.01),两组组织类型构成不同(χ2=13.53,P＜0.01);(3)Logistic回归模型分析发现,影响胸膜凹陷形成的主要因素依次为瘤内纤维化(/=6.851,P＜0.01)、瘤-壁距离(χ2=6.684,P＜0.01)、组织类型(χ2=5.338,P=0.021),与肿瘤大小、分化程度、淋巴结转移及性别无明显关系(χ2=0.000,2.308,1.116,3.034,P＞0.05).结论周围型肺癌胸膜凹陷征形成的主要基础是间质Ⅰ型胶原纤维,成纤维母细胞为主要间质细胞基础;影响因素主要为瘤内纤维化、瘤-壁距离和组织类型,瘤内纤维化为根本的内因,肺癌组织类型影响胸膜凹陷的形成,瘤-壁距离为重要的外因.     

白细胞介素22在结核性胸膜炎与恶性胸腔积液中生物学特性的研究进展

白细胞介素22（IL-22）是IL-10细胞因子家族成员之一,通过与IL-22R1、IL-10R2二聚体结合发挥作用。主要由T辅助细胞(T-helper cell)22（Th22）、Th17和Th1细胞表达,部分自然杀伤细胞（NK细胞）、γδT（T细胞受体的一种）细胞和淋巴组织可诱导（LTi）细胞也可表达。结核性胸腔积液和恶性胸腔积液中都存在显著升高的IL-22,主要来源于受趋化因子作用募集于胸膜腔的外周血CD4⁺ T淋巴细胞和胸膜腔局部在IL-6、IL-23、IL-1β和肿瘤坏死因子-α（TNF-α）等细胞因子作用下分化而来的CD4⁺ T细胞。在胸膜腔中,IL-22通过促进基质金属蛋白酶（matrix metalloproteinases,MMPs）的表达发挥免疫病理作用,并通过介导NK细胞产生溶解因子减少寄生于单核细胞来源的巨噬细胞内的结核分枝杆菌生长。在恶性胸腔积液中,IL-22可通过促进肿瘤细胞增殖、迁移,并且通过增加黏附分子的表达促进与胸膜间皮细胞（pleural mesothelial cells,PMCs）的黏附发挥作用。研究IL-22在上述两种疾病中的作用机制,将会为免疫诊断与治疗开辟新的途径。     

胸腔积液患者血浆及胸液中血管内皮生长因子测定的临床意义

目的：探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)在恶性胸腔积液患者血浆及胸液中的含量与积液种类和预后之间的关系。方法：采用双抗体夹心ELISA法检测肺癌并恶性胸液（n=32）、结核性胸液（n =34）、漏出性胸液（n =9）患者胸液及血浆中VEGF含量,同时检测各组患者胸液中癌胚抗原（CEA）、腺苷脱氨酶（ADA）的水平。结果：胸液及血浆中VEGF含量在肺癌并恶性胸液（345±167)、(120±79）ng/l显著高于结核性胸液（119±52)、(53±20)ng/L和漏出性胸液（57±22)、(35±12)ng/L,（P均＜0.05）;结核性胸液高于漏出性胸液(P＜0.05）。肺癌并恶性胸液生存期＜6个月者（386±185)ng/L明显高于生存期＞12个月者（201±88)ng/L,（P＜0.05）。VEGF与CEA及LDH水平呈显著正相关（r=0.51,r=0.46,P＜0.01）而与ADA、葡萄糖、蛋白质含量、白细胞总数及分类计数之间无明显相关（P＞0.05）。VEGF对良恶性胸液诊断的灵敏度为75.6%,特异度为73.5%（界值为221ng/L）。结论：VEGF在恶性胸液的形成中起重要作用,其水平高低与预后有关,检测胸液VEGF水平有助于良恶性胸液的鉴别。