• Tuberculosis and Respiratory Diseases
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• v.67 no.5
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• pp.458-461
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• 2009

A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.

• Tuberculosis and Respiratory Diseases
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• v.80 no.2
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• pp.194-200
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• 2017

Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were $50{\mu}g$ and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.

• Tuberculosis and Respiratory Diseases
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• v.76 no.4
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• pp.175-178
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• 2014

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

• Tuberculosis and Respiratory Diseases
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• v.38 no.3
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• pp.262-269
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• 1991

The purpose of this study is to investigate the utility of the pleural fluid cholesterol level in separating the exudates from the transudates, and in differentiating tuberculous exudates from non-tuberculous exudates, 52 patients with pleural effusion were involved in this prospective study. By predefined criteria, 40 of these effusions were classified as exudates (Group I) and 12 as transudates (Group II). Group I was subdivided into tuberculous exudates (Group A) and non-tuberculous exudates (Group B). The followings are parameters used in separating the exudates from the transudates; pleural protein (P-PROT) 3.0 g/dl, pleural protein/serum protein ratio (P/S PORT) 0.5, pleural LDH (P-LDH) 200 IU, pleural LDH/serum LDH ratio (P/S LDH) 0.6, pleural cholesterol (P-CHOL) 50 mg/dl and pleural cholesterol/serum cholesterol ratio (P/S CHOL) 0.4. Mean values of the parameters in each group were compared, and then misclassified rate and the dignostic efficiency for each parameter were calculated. The results were as follows; 1) Mean P-CHOL ($94.98{\pm}73.86\;mg/dl$) in Group I was higher than that ($36.5{\pm}26.5\;mg/dl$) in Group II (p<0.05), but there was no significant difference in mean P-CHOL between Group A and Group B. 2) Mean P/S CHOL ($0.64{\pm}0.39$) in Group I was also higher than that ($0.27{\pm}0.15$) in Group II (p<0.01), but no difference was observed in mean P/S CHOL between Group A and Group B. 3) Misclassified rates for each parameter in separating the exudates from the transudates were as follows; P-PROT 1.9%. P/S PROT 3.8%. P-CHOL 9.6%, P/S CHOL 11.5%, P/S LDH 11.5%, and P-LDH 17.3%. 4) Diagnostic efficiencies for each parameter in separating the exudates from the transudates were as follows; P-PROT 98.1%, P/S PROT 96.2%. P-CHOL 90.4%. P/S CHOL 88.5%, P/S LDH 88.5%, and P-LDH 82.7%. In conclusion, we think that the pleural fluid chloesterol level could be used as a supportive parameter in separating the exudates from the transudates, but could not be used as a parameter in differentiating tuberculous exudates from non-tuberculous exudates.

• Tuberculosis and Respiratory Diseases
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• v.48 no.5
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• pp.781-787
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• 2000

Background : The established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiating the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiating pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. Methods : A total of forty-three patients with known causes of the pleural of the pleural effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Ligt's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio, the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. Results : The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol 2.3% ; pleural fluid to serum cholesterol, ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum chlinesterase ratio, 2.3%. Conclusions : The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If fur1her studies confirm the results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and, if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.

• Tuberculosis and Respiratory Diseases
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• v.62 no.6
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• pp.486-491
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• 2007

Background: This study examined the relationship between the pleural adenosine deaminase (ADA) level and the patterns of pleural enhancement in patients with a tuberculous pleural effusion (TPE) shown on a CT scan. Methods: The charts and CT findings of 44 patients with TPE from February 2002 to October 2006 were reviesed retrospectively. A diagnosis of TPE was made by the pleural ADA level with a follow-up (24/44), sputum smear or culture of sputum (16/44), pleural fluid culture (3/44) or pleural biopsy (1/44). The patients were divided into two groups according to the ADA level(Group I [n=12]: 40-70, Group II [n=32]: >70 U/L). The presence or absence, maximal thickness and patterns of pleural enhancement were analyzed. The pattern of pleural enhancement was classified into diffuse or focal, smooth or irregular and interrupted or continuous. The difference in CT findings between groups I and group II were analyzed using an unpaired T test, Chi-square test and Z test. Results: All 44 patients showed diffuse pleural enhancement on the CT scans. The maximal pleural thickness of groups I and II was $1.83{\pm}1.03mm$ (1-4 mm) and $3.63{\pm}1.78mm$ (1-8 mm), respectively (p =0.0002). Pleural thickening ${\geq}5mm$ was only demonstrated in 31.3% of patients in group II (10/32). Diffuse interrupted pleural thickening was noted in 91.7% (11/12) of patients in group I and 62.5% (20/32) in group II, respectively. Diffuse continuous pleural thickening was observed in 8.3% (1/12) of patients in group I and 37.5% (12/32) in group II, respectively (p=0.0748). Conclusion: Pleural thickening ${\geq}5mm$ on the contrast enhanced CT is rare in patients with lymphocyte-dominant TPE in whom the pleural ADA level is between 40-70 U/L.

• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.565-573
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• 1998

Malignant pleural effusions are most commonly associated with lung cancers, however, it also can be resulted from breast cancers, ovarian cancers, stomach cancers and so on. According to the their histologic types, adenocarcinoma have been known as the most common cell type of malignant pleural effusions and squamous cell carcinoma is rare. We herein present incidences, clinical characteristics and survivals of malignant pleural effusions according to their cell types and primary diseases. The objects are 84 malignant pleural effusion patients diagnosed by pleural fluid cytologic examination or pleural biopsy from Jan. 1992 to May. 1997 in Seoul National University Hospital. A retrospective chart review on their histologic types, biochemical parameters and survivals is described. Among 84 patients, 52 were males and the other 32 were females with 1.6:1 of male and female ratio and their mean age was 57.6 years old. Common symptoms of them wele dyspnea, cough, sputum and pleuritic chest pain. The proportions of bloody nature of effusion, lymphocyte dominant pleural effusion, exudative effusions were 66%, 39% and 93%, respectively. They consisted of 54 cases of adenocarcinoma(33 cases of them were lung cancers), and 10 cases of squamous cell carcinoma (8 cases of them were lung cancers), 10 cases of malignant lymphoma, 8 cases of small cell lung cancer and a case of mesothelioma and leukemia. There was no differences in characteristics of effusions, clinical features and survivals between each histologic cell types. Analyzing them according to primary diseases, no difference except longer survivals in malignant pleural effusions from breast cancer than from other cancers was observed. In conclusion, considering the incidences of histologic types of lung cancers during same period (squamous cell carcinoma; 47%, adenocarcinoma; 33%, small cell lung cancer; 12% and large cell carcinoma; 2%), malignant pleural effusions more likely occurred in adenocarcinoma than other cell types of lung cancers and there was no significant difference of clinical characteristics between histologic types.

• Childhood Kidney Diseases
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• v.27 no.1
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• pp.46-53
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• 2023

Pleuroperitoneal communication (PPC) is a rare mechanical complication of peritoneal dialysis (PD), which causes dialysate to move from the peritoneal cavity to the pleural cavity, resulting in pleural effusion. Typically, PPC is discovered through pleural effusion in PD patients who are not in volume overload status. A unique characteristic of the pleural effusion caused by PPC is that it is not resolved by increasing ultrafiltration by dialysis. In this report, we present a 7-year-old girl with PD after birth with the history of various infectious PD-related complications, presenting with fever ongoing for 6 months. PPC-associated pleuritis was suspected as the cause of fever, which eventually developed after long-term PD and induced complicated pleural effusion, lung inflammation, and prolonged fever for 6 months.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.184-191
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• 2007

Background: For the diagnosis of pleural tuberculosis, polymerase chain reaction (PCR) of pleural effusion specimens has shown very low sensitivity, which might be due to the small number of bacilli in the samples. The purpose of this investigation is to determine whether the sensitivity of PCR testing can be improved when increasing the amount of pleural effusion specimens. Methods: We prospectively analyzed pleural effusion specimens obtained from 53 patients for whom the exclusion of the possibility of tuberculous pleural effusion was necessary. We performed Mycobacterium tuberculosis PCR testing using the Cobas Amplicor MTB test (Roche Diagnostic Systems) with three different amounts (10ml, 25ml, and 50ml) of pleural effusion specimen in each patient. Pleural tuberculosis was defined as having one of the following: culture-positive pleural fluid sample, histopathologic finding consistent with tuberculosis on pleural biopsy, culture-positive sputum specimen, and/or positive response to anti-tuberculous medication without other possible causes of pleural effusion. Results: Of the 53 patients, 26 received the diagnosis of pleural tuberculosis. The sensitivities of AFB smearing, Mycobacterium tuberculosis culture of pleural effusion specimen, pleural biopsy, and measurement of ADA were 3.8%, 15.4%, 84.6%, and 88.5%, respectively. The results of PCR testing were positive for 3 (11.5%), 4 (15.4%), and 3 (11.5%) of the 26 patients when using 10ml, 25ml, and 50ml of pleural effusion specimens, respectively. These results did not show a statistically significant difference in the sensitivity of PCR testing when increasing the amount of pleural effusion samples (p>0.05, symmetry exact test). Conclusion: For specimens such as pleural effusion, in which the bacillary load is very low, the clinical utility of PCR testing seems highly limited with the kits designed for the diagnosis of pulmonary tuberculosis. An increased amount of pleural effusion sample does not improve the sensitivity of PCR testing.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.361-367
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• 2005

Background : Differential diagnosis of lymphocytic pleural effusion is difficult even with many laboratory findings. Nitric oxide(NO) level is higher in the sputum or exhaled breath of patients with active pulmonary tuberculosis than in those without tuberculosis. In addition, there are some reports about the increased level of NO metabolites in body fluids of cancer patients. However, there is no data on the NO levels in the pleural fluid of patients with tuberculous pleurisy. Method : The serum and pleural fluid NO in the patients with acute lymphocytic pleural effusion were analyzed. Results : Of total 27 patients, there were 14 males and average age of patients was 48 years. The final diagnosis was tuberculous pleurisy in 17 cases and malignant pleural effusion in 10. The pleural fluid NO level was $540.1{\pm}116.4{\mu}mol$ in the tuberculous pleurisy patients and $383.7{\pm}71.0{\mu}mol$ in the malignant pleural effusion patients. The serum NO level was $624.7{\pm}142.0{\mu}mol$ in tuberculous pleurisy patients and $394.4{\pm}90.4{\mu}mol$ in malignant pleural effusion patients. There was no significant difference in the serum and pleural fluid NO level between the two groups. The NO level in the pleural fluid showed a significant correlations with the pleural fluid neutrophil count, the pleural fluid/serum protein ratio, and pleural fluid/serum albumin ratio (p<0.05 in each). The protein concentration, leukocyte and lymphocyte count in the pleural fluid were significantly higher in the tuberculous pleurisy patients than the malignant pleural effusion patients (p<0.05 in each). Conclusion : NO is not a suitable marker for a differential diagnosis of lymphocytic pleural effusion. However, the NO level in the pleural fluid might be associated with the neutrophil recruitment and protein leakage in the pleural space.