• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.135-143
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• 1994

Background: The cell mediated immunity has an important role in the pathogenesis of tuberculosis. sIL-2R has been known as a sensitive marker of T lymphocyte activation Elevated serum levels of sIL-2R have been found in patients with lymphoproliferative disorders, organ transplantation, autoimmune diseases, and various granulomatous diseases. Elevated levels of sIL-2R have been also found in the serum and pleural fluid of the patients with tuberculosis. To evaluate the diagnostic value of sIL-2R in the differentiation of tuberculous pleurisy and nontuberculous pleurisy. We measured the level of sIL-2R in the sera and pleural fluids of 12 patients with tuberculous pleurisy and 32 patients with nontuberculous pleurisy. Method: Samples of pleural fluid and serum were centrifuged at 2500 rpm for 10 min to remove cell pellets. Soluble IL-2R was measured with a sandwitch enzyme immunoassay using the Cellfree(r) Interleukin-2 Receptor Test kit(T-cell science,Inc. Cambridge, MA). Results: The results obtained were as follows: 1) The sIL-2R level in pleural fluid of the patients with tuberculous pleurisy was higher than that of patients with nontuberculous pleurisy(P<0.005). 2) When the sIL-2R level above 5,000 u/ml in pleural fluid was used as the cut-off value to diagnose tuberculous pleurisy, it had a sensitivity of 84.6% and a specificity of 90.9%. 3) The sIL-2R level in the sera of the patients with tuberculous pleurisy was higher than that of patients with bacterial pleural effusions and normal control group(P<0.05) and there was no difference of levels compared with malignant pleural effusions and transudative pleural effusions(P>0.05). 4) In patients with tuberculous pleurisy, the mean concentration of sIL-2R in pleural fluid was higher than that in serum(P<0.005). Conclusion: These findings suggest that the measurement of elevated levels of pleural fluid sIL-2R in tuberculous pleurisy may be useful in the differential diagnosis between patients with tuberculous pleurisy and nontuberculous pleurisy.

• Journal of Yeungnam Medical Science
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• v.6 no.1
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• pp.69-80
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• 1989

From December 1987 to September 1988, clinical evaluation were performed at the Yeungnam University Hospital on 138 patients with exudative pleural effusion comparing with biochemical, bacteriologic, cytologic and pathologic studies. The results were as follows 1. Among thease 138 cases, Incidence of tuberculosis was 57.3%, neoplasm 26.8%. High tendency in malignant pleural effusion occured in elder age. 2. In tuberculosis pleural effusion, the rate of positive smear and culture for acid-fast bacilli in the pleural fluid was 3.7% and positive biopsy for granuloma 75%. 3. In malignant pleural effusion, the rate of positive cytology for cancer cell in the fluid was 42% and positive biopsy 60%. 4. Analysis in tuberculosis and malignancy showed the tendency of high pH, WBC, protein and of low glucose, but there were clinically not significant in differentiating malignant pleural effusion from tuberculous pleural effusion. 5. Among 23 cases in which the pleural tissue findings were chronic nonspecific reaction pathologically, tuberculosis(52.2%), malignancy(26%) and idiopathic(21.8%) eventually in follow up studies.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.584-594
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• 1993

Background: Among the respiratory diseases, there are a lot of cases of pleural effusion. The most common cause is tuberculosis. But the other cause such as lung malignancy is in an increasing tendency because of the development of diagnostic procedure, the decrease of the prevalence of the tuberculosis and the increase of the longevity. We need to know the accurate diagnosis as soon as possible for the correct therapy. Method: A clinical observation was made on 315 cases of pleural effusion seen at Pusan Adventist Hospital, from Jan, 1989 to Dec, 1992. For diagnostic procedure, thoracentesis, lymph node biopsy, bronchoscopy and percutaneous biopsy of the parietal pleura with Cope needle were performed. The following are parameters used in seperating the exudate from the transudate: pleural protein 3.0 g/dl, pleural protein/serum protein ratio 0.5, pleural LDH 200 IU, pleural LDH/serum LDH ratio 0.6, pleural cholesterol 60 mg/dl and pleural cholesterol/serum cholesterol ratio 0.3. Each parameters were compared, and misclassified rate and diagnostic efficiency were calculated. Results: The most common cause of exudate pleurisy was tuberculosis (82.3%) and malignancy was next (12.2%). The chief complaints of pleural effusion were noted as dyspnea (58.7%), chest pain (54.9%), coughing (50.2%) and fever (36.2%). Location of pleural effusion was noted as right side (51.4%), left side (41.3%) and both sides (7.3%). Amount of pleural effusion of the chest X-ray was minimum (46.8%), moderate (40.5%) and maximum (12.7%). Misclassified rates for each parameters in seperating the exudates from the transudates were as follows; protein: 5.2%, pleural protein/serum protein:7.6%, LDH: 13.9%, pleural LDH/serum LDH: 6.9%, cholesterol: 8.0%, pleural cholesterol/serum cholesterol: 5.6%. On the pleural biopsy, the tuberculosis granuloma was 60.8%, malignancy was 13.6%, infection was 2.3% and nonspecific inflammatory reaction was 23.3%. Conclusion: on the basis of the above results, the most common cause of exudative pleurisy was tuberculosis. We think that the plerual cholesterol/serum cholesterol ratio is the most useful supportive parameter in separating the exudates from the transudates. For accurate diagnosis, the pleural biopsy is the first procedure and repeated pleural biopsy of nonspedcific inflammatory reaction is required.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.436-439
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• 1998

Mediastinal teratoma is a tumor that thoracic surgeons made an operation much less commonly than other mediastinal masses and most of them are asymptomatic. But very rarely, this tumor invades the pleura and pericardium resulting in pleural effusion, pericardial effusion and cardiac tamponade in severe cases. The mechanism of invasion and perforation of the tumor is unknown and tumor-consisting tissue factor is suspected of a cause. In this case, we operated on a patient whose anterior mediastinal teratoma invaded and perforated pericardium and pleura resulting in pericardial effusion and pleural effusion. The patient was improved and discharged with no problem after resection of mass and involved pericardium.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.899-906
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• 1997

Background : The percutaneous pleural needle biopsy have been regarded as cornerstone in the diagnosis of lymphocyte dominant pleural effusions of which acid fast bacilli smear and cytologic exam was negative. However, the complications of percutaneous pleural needle biopsy is not rare and its diagnostic efficacy is not always satisfactory. Recently, pleural fluid adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) are widely accepted as markers of tuberculous pleurisy and malignant pleural effusion respectively. We designed this study to re-evaluate the role of percutaneous pleural needle biopsy in the diagnosis of lymphocyte dominant exudative pleural effusions whose AFB smear, cytologic exam was negative. Method : Retrospective analysis of 73 cases of percutaneous pleural needle biopsy in case of lymphocyte dominant exudative pleural effusions whose AFB smear and cytoloic exam was negative from Jan 1994 to Feb 1996 was done. Result : In 35 cases, specific diagnosis was obtained(all cases were tuberculous pleurisy), and in 30 cases specific diagnosis was not obtained in spite of getting adequate pleural tissues, and in the other 8 cases, percutaneous pleural biopsy failed to get pleural tissues. In 9 cases, complications were combined including pneuomothorax and hemothorax. All 49 cases of pleural effusions whose ADA value was higher than 40IU/L and satisfying other categories were finally diagnosed as tuberculous pleurisy, however, the pleural biopsy confirmed only 28 cases as tuberculous pleurisy. In 6 cases of pleural effusions of which CEA value is higher than 10ng/ml, the pleural biopsy made specific diagnosis in no case. Final diagnosis of above 6 cases consisted of 4 malignant effusions, 1 malignancy associated effusion and 1 tuberculous pleurisy. Conclusion : In the diagnosis of 73 cases of lymphocyte dominant pleural effusions of which acid fast bacilli smear and cytologic exam was negative, percutaneous pleural biopsy diagnosed only in 35 cases. In the diagnosis of tuberculous pleurisy, the positive predictive value of higher ADA than 40 IU/L in lymphocyte dominant pleural effusion with negative AFB smear and negative cytologic exam was 100%. And the diagnostic efficacy of pleural biopsy was 57%. In cases of effusions with high CEA than 10ng/ml 83% and 0% respectively. Finally, we concluded that percutaneous pleural needle biopsy in the diagnosis of AFB smear negative and cytologic exam negative lymphocyte dominant exudative pleural effusion was not obligatory. especially in effusions with high ADA and low CEA value.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.193-199
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• 1986

Body fluid Lactate dehydrogenase and its isoenzyme measurement was performed in 132 patients: 8 cases with peritonitis, 21 cases with malignant ascites, 43 cases with liver cirrhosis, 48 cases with tuberculous pleuritis, 12 cases with malignant pleural effusion respectively. Body fluid protein and glucose contents, red blood cell counts, white blood cell counts, cytologic examination were also performed as a comparative study. The results were as follows: 1. Measurement of total LD and protein amount could differentiate between transudate and exudate in the ascitic fluids. 2. In the malignant exudate of ascites and pleural fluid, the activity of LD2 isoenzyme was statistically increased compared with that of inflammatory exudate and the activity of LD4 isoenzyme was also increased compared with that of serum(P<0.05). 3. The inflammatory exudate of pleural fluid and ascites demonstrated the increase of LD5 isoenzyme activity stastistically compared with that of serum and malignant exudate(P<0.05). 4. A difference of total LD activity between malignant ascites and inflammatory ascites was significant statistically, while this was not observed in the pleural exudate. 5. Total LD and LD5 isoenzyme activity didn't correlated with the number of white blood cells in the exudate.

• The Korean Journal of Pharmacology
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• v.23 no.2
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• pp.151-157
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• 1987

Cyclobuxine D, a steroidal alkaloid, was extracted from Buxus microphylla var. koreana Nakai. The effects of cyclobuxine D on carrageenin-induced pleurisy and croton oil-induced granuloma pouch in rats was investigated and compared with those of aspirin, hydrocortisone ana dexamethasone. Intrapleural injection of 2% carrageenin caused the accumulation of exudate. The rate of plasma exudation, measured by the exuded dye amounts for 20 min in the pleural cavity after intravenous injection of pontamine sky blue, showed a peak at 5 hr. Cyclobuxine D (5, 20 and 50 mg/kg, i.p.) suppressed dose-dependently the accumulation of the pleural exudate and the exudation of dye. Among several methods used for screening and evaluation anti-inflammatory agents, granuloma pouch technic introduced by Hans Selye (Hans seyle, 1953) is considered as a simple and reliable method. An air pocket was produced in the subcutaneous tissue of the interscapular region by injection of 1 ml of 1% croton oil as irritant. Inflammatory exudate accumulated in the pouch during the succeding 14 days. Cyclobuxine D (5 and 20 mg/kg) decreased fluid volume in pouch and weight of pouch wall in granulomatous inflammation.

• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1459-1465
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• 2020

The perforation of the intrathoracic internal jugular vein during the placement of an implantable central venous chemoport is a rare complication that is manifested by hemothorax or hemorrhagic shock. Furthermore, inappropriate instillation of a chemotherapeutic agent in the chemoport can cause chemical pleuritis, and the diagnosis of these complications prior to the instillation of chemotherapeutic agents and open thoracic surgery is mandatory. We report a patient with chemical pleuritis and hemothorax following an inappropriate instillation of a chemotherapeutic agent, through the perforated right internal jugular vein after placement of an implantable central venous chemoport. Treatment by embolization using coils and N-butyl cyanoacrylate, after percutaneous drainage, was successful.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.492-498
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• 2007

Background: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. Material and Method: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). Result: The durations of chest tube placement after the procedure were $7.0{\pm}4.0$ days (group A) and $6.7{\pm}3.6$ days (group B). The hospital stays were $24.3{\pm}9.4$ days (group A) and $30.7{\pm}21.5$ days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group $A=8.5{\pm}2.2$ months, group B $8.0{\pm}7.4$ months). The collapsed portions of lung were better expanded in group A than in group B (p-value=0.011). Conclusion: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.1
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• pp.81-86
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• 2005

Massive pancreatic pleural effusion is a rare complication of chronic pancreatitis. It results from leakage of pancreatic secretion into the pleural space through the aortic or esophageal hiatus, either by a pancreatic duct disruption or communicating pseudocyst. The presentation of the pancreatic pleural effusion is often misleading as respiratory rather than abdominal symptoms because of predominance of pulmonary complaints. Markedly elevated amylase level of the pleural fluid is highly suggestive of the diagnosis. We experienced a case of chronic pancreatitis with massive pleural effusion in a 9-year-old female, who presented with a 6-months history of intermittent abdominal pain, and cough and chest pain for 3 days.