Neonatal pleural empyema in an extremely low birth weight infant

Pleural empyema is rarely seen in the newborn period. Here we report the first case of exclusive and successful conservative management of pleural empyema in an extremely low birth weight infant. Chest drainage or percutaneous aspiration was not feasible. Noninvasive treatment might represent an acceptable option in premature infants.     

Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma

Background

Malignant mesothelioma (MM), a primarily asbestos-induced tumour, has a poor prognosis, with over-all 5-year survival less than 5%. Tumour biomarkers are being intensely investigated in MM as aids to diagnosis and prognosis. Hyaluronic acid (HA) is produced in MM but its role in prognostication remains uncertain.

Materials and methods

HA concentrations were determined in matching serum and pleural effusion of 96 MM patients, 26 lung cancer patients and 42 patients with benign effusions resulting from infectious, cardiac, renal, liver and rheumatoid diseases and compared to the current ‘best practice’ biomarker, mesothelin. Liver and kidney function were determined for each patient. Diagnostic accuracy was determined by area under the receiver operator characteristic curve (AUC) analysis following logistic regression modelling. Difference in survival between groups was determined by both log-rank test and Cox proportional hazards regression modelling.

Results

For effusion HA, the AUC (IQ range) was 0.89 (0.82–0.94) and for effusion mesothelin, it was 0.85 (0.78–0.90). Serum HA was not diagnostically useful. A combined measure of effusion HA, and serum and effusion mesothelin had an AUC of 0.92 (0.86–0.96), which was significantly higher than effusion mesothelin alone. Effusion HA had a biphasic distribution in MM patients, dichotomised at a concentration of 75 mg/L. The median survival of MM patients with high effusion HA was 18.0 (13.7–22.4) months, significantly longer than those with low HA effusion levels (12.6 months (8.4–16.8), p = 0.004). Serum HA, and effusion and serum mesothelin were not significant prognostic indicators.

Conclusion

This study demonstrates that a combined biomarker panel has greater diagnostic accuracy than effusion mesothelin alone, and that significant prognostic information is provided by effusion HA.     

可溶性Apo-1/Fas对结核性和恶性胸腔积液的鉴别诊断价值

目的 通过检测血清及胸水中可溶性Apo-1/Fas(sApo-1/Fas)的水平,探讨其对鉴别良恶性疾病的意义.方法 采用酶联免疫吸附法(ELISA)法检测50例恶性胸腔积液患者和48例结核性胸腔积液患者血清和胸水中sApo-1/Fas的含量.结果 恶性胸腔积液患者血清和胸水中sApo-1/Fas的含量分别为(16.3±2.5)μg/L、(38.6±13.5) μg/L,均明显高于结核性胸腔积液组(均P＜0.05).两组胸水/血清sApo-1/Fas比值差异有统计学意义(P＜0.05).血清sApo-1/Fas+胸水sApo-1/Fas对恶性胸腔积液诊断的敏感度为66.0％、特异度为93.8％、准确度为79.6％.结论 血清和胸水中sApo-1/Fas的测定有利于良恶性胸水的鉴别.     

深部热疗联合胸腔灌注化疗治疗恶性胸腔积液的观察及护理

目的探讨胸腔置管引流并腔内灌注化疗药物联合深部热疗治疗恶性胸腔积液的疗效及护理。方法 60例恶性胸腔积液患者均采用中心静脉导管作胸水引流,胸腔内交替注入顺铂、白细胞介素-II,每周1～2次,联合胸部热疗,隔日1次,6次为1个疗程,治疗中配合相应的护理。结果 60例患者均能耐受治疗,完成1～3个疗程,有2例出现堵管,1例热疗时出现皮肤红斑,其余无严重并发症。结论深部热疗联合胸腔内灌注化疗已成为治疗恶性胸腔积液的有效方法,做好治疗中引流管的护理和热疗的护理,减少不良反应,防止并发症,是持续治疗的重要环节。疗效     

1例肺癌并发恶性胸腔积液患者的药学监护

回顾性分析临床药师参与1例肺癌并发恶性胸腔积液患者的治疗过程,从抗感染治疗、化疗和恶性胸腔积液治疗等方面进行归纳和总结,探讨临床药师参与肺癌并发恶性胸腔积液患者治疗的药学监护切入点. 通过药学监护,患者的感染和恶性胸腔积液症状得到有效改善,避免严重不良反应的发生. 对肺癌并发恶性胸腔积液患者提供个体化的药学监护,可提高治疗效果,改善患者的生活质量.     

胸后壁胸膜腔穿刺安全区的定位

目的探究胸后壁第六至第九肋间隙肋间神经和肋间后血管的走行及位置关系,为临床在胸后壁行胸膜腔穿刺确定在肋间隙进针的安全区域。方法在32具成人尸体上,解剖胸后壁第六至第九肋间隙的肋间神经和肋间后血管,观察它们的走行及位置关系,测量肋间神经和肋间后动脉、静脉各自的分叉点及各自的下支与下位肋上缘交点距后正中线和肩胛线的距离,并进行统计学分析。结果肋间神经、血管在排列和分布上呈现一定的规律。结论根据肋间神经和肋间后血管在胸后壁的走行和位置状况可确定胸腔穿刺术的安全进针区。     

Pleural effusions

There are many diseases that cause pleural effusions. When a patient with a pleural effusion is first evaluated, one should determine if the patient has a transudate or an exudate. A diagnostic approach to the patient with an?undiagnosed pleural effusion is outlined. The most common pleural effusions including those caused by congestive heart failure, cirrhosis, pneumonia, malignancy, tuberculosis, lupus erythematosus, rheumatoid disease, and chylothorax are discussed.     

儿童胸膜肺母细胞瘤一例诊治分析

目的探讨胸膜肺母细胞瘤(pleuropulmonary blastoma,PPB)的临床特点及诊断要点。方法回顾分析1例PPB的临床资料。结果患儿因肠套叠入院常规行胸部X线检查发现右下肺类圆形气性密度影,其边缘清晰,内未见液平面。本例临床无明显呼吸道症状,CT检查见右下肺透亮度增加,有一薄壁气囊,囊内见薄分隔,诊断先天性孤立性肺囊肿。2年后复查病灶增大,行手术治疗,术中见右肺下叶囊实性肿物,行右肺下叶切除术,术后病理诊断为PPB。结论 PPB临床罕见,无症状者需密切随访,确诊后应及时手术并辅以化疗、放疗。     

超声引导胸腔穿刺留置猪尾导管治疗复杂性肺炎旁胸腔积液

目的 探讨超声引导胸腔穿刺留置猪尾导管治疗复杂性肺炎旁胸腔积液的价值.方法 临床确诊的复杂性肺炎旁胸腔积液116例,随机分为两组:治疗组58例采用超声引导胸腔穿刺留置猪尾导管治疗方法;对照组58例,采取常规胸腔闭式引流的方法.两组患者均同时进行全身支持疗法及抗生素治疗.比较两组患者在退热时间、胸腔积液吸收时间、住院天数、治疗后胸膜的厚度、肺功能指标、置管后患者视觉模拟评分等方面的差异.结果 两组间的退热时间、胸腔积液吸收时间、住院天数、治疗后胸膜的厚度、肺功能指标、置管后患者视觉模拟评分比较差异均具有统计学意义(P＜0.05).结论 超声引导胸腔穿刺留置猪尾导管治疗复杂性肺炎旁胸腔积液的方法明显优于传统治疗方法.

Abstract：

Objective To study the value of ultrasound-guided thoracic puncture to indwell pigtail catheter for treating the complicated parapneumonic pleural effusion. Methods One hundred and sixteen patients,clinically diagnosed the complicated parapneumonic pleural effusion,were randomly divided into the treatment group(58 cases) and the control group(58 cases). In the treatment group, patients were treated by ultrasound-guided thoracic puncture to indwell pigtail catheter. In the control group, patients were treated by conventional closed thoracic drainage. At the same time, systemic supportive therapy and antibiotics were given to all patients of two groups. The time of defervescence,the time of pleural effusion absorbed,days in hospital,the thickness of the pleura after treatment, indices of pulmonary function and the visual analogue scales after indwelling catheter were observed. Results In the time of defervescence, the time of pleural effusion absorbed ,days in hospital, the thickness of the pleura after treatment, indices of pulmonary function and the visual analogue scales after indwelling catheter,the differences between two groups were significant (P ＜ 0. 05). Conclusions For complicated parapneumonic pleural effusion, the method by ultrasoundguided thoracic puncture to indwell pigtail catheter is obviously superior to the traditional method.     

胸腔积液中腺苷脱氨酶的临床检测意义分析

目的探讨胸腔积液中腺苷脱氨酶的临床检测意义。方法选择本院结核性胸腔积液患者共35例,作为结核组：同时选择本院肿瘤性胸腔积液患者共30例,作为肿瘤组。取两组患者胸腔积液,测定腺苷脱氨酶活性。结果结核组胸腔积液中腺苷脱氨酶活性显著高于肿瘤组,差异有统计学意义（P〈0．05）;结核组胸腔积液中腺苷脱氨酶阳性检出率显著高于肿瘤组,差异有统计学意义（P〈0．05）。结论胸腔积液患者中行胸腔积液腺苷脱氨酶活性检测有助于结核性胸腔积液和肿瘤性胸腔积液鉴别诊断,检测意义重要,值得借鉴。