Pleural fluid amino-terminal brain natriuretic peptide in patients with pleural effusions.

BACKGROUND: Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure-related pleural effusions from non-heart-failure effusions. METHODS: Sixty-six subjects (40 male, mean age 61 ± 18 y) with pleural effusions were included. Samples of pleural fluid and serum were obtained simultaneously from each subject. Biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture, and cytology were performed on the pleural fluid. RESULTS: Subjects with heart-failure-related pleural effusion had significantly higher pleural NT-proBNP levels than other subjects (P < .001). Pleural and serum NT-proBNP measures were closely correlated (r = 0.90, P < .001). An NT-proBNP cutoff value of ≥ 2,300 pg/mL in pleural fluid had a sensitivity of 70.8%, a specificity of 97.6%, and positive and negative predictive values of 94.4% and 85.4%, respectively, for discriminating transudates caused by heart failure from exudates. Eight heart-failure subjects were misclassified as exudates by Light's criteria, 5 of whom received diuretics before thoracentesis. All misclassified subjects had pleural NT-proBNP levels higher than 1,165 pg/mL, which predicted heart-failure-associated transudates with 95.8% sensitivity and 85.7% specificity. CONCLUSIONS: Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.

Malignant mesothelioma associated with chronic empyema with elevation of serum CYFRA19: A case report.

Malignant neoplasms are reported to occur with long-standing tuberculous pleuritis or chronic empyema. During the clinical course of chronic empyema, subjective symptoms such as chest pain and deterioration of dyspnea and abnormal clinical signs such as increased abnormal chest shadows have frequently been found. Though difficult, differentiating the occurrence of malignant tumors from worsening chronic inflammation is crucial. We report here a case of malignant mesothelioma associated with chronic empyema with elevation of serum CYFRA19.

[Megakaryocytopoiesis in patients with acute infectious destruction of the lungs]. / Megakariotsitopoèz u bol'nykh ostrymi infektsionnymi destruktsiiami legkikh.

Partial megakaryocytograms were studied in patients with acute infectious destructions of the lungs. Acid phosphatase and glycogen megakaryocytic levels, overall number of megakaryocytes elucidated the role of the central link of the system megakaryocyte--platelet in the onset of thromboembolism and hemorrhagic complications arising in the above patients. Inefficiency of megakaryocytopoiesis in pulmonary and pleural acute pyo-destructions is under discussion.

[Participation of leukocytes in primary hemostasis]. / Uchastie leikotsitov v pervichnom gemostaze.

Introduction of a hemolysate of erythrocytes and ADP in the plasma containing leucocytes and platelets results in the formation of mixed-cell (leucocytic-thrombocytic) aggregates, aggregation rate depending on the number of leucocytes involved. In healthy donors this process is ensured equally by both cell types. In inflammation and especially in chronic myelocytic leukemia leucocytes play the main role in mixed-cell aggregation. Aggregate formation in such patients is characterized by a high intensity which may be related with an increase in total function of pathological leucocytes.

[Method of estimating kininogenesis in blood plasma]. / Metod otsenki kininogeneza v plazme krovi.

It is suggested that the kininogenesis should be assessed from 3 forms of kallikrein which are detected on the basis of their kininogenase activity in whole blood plasma. Heating of blood plasma acidified to pH 3.0 for 15-20 min at 61 degrees C allows for the conditions under which the kallikrein inhibitors (alpha 1-antitrypsin, alpha 2-macroglobulin) are destroyed whereas kallikrein, prekallikrein, low- and high-molecular kininogens (HMK) are preserved, thus constituting a complex of proteins making the kininogenase reaction feasible. Addition of purified preparations of HMK to the neutralized samples of normal and sick individuals' plasma permitted the demonstration that as the kallikrein is raised, the kininogenesis gets actually activated, during which the blood manifests, in the presence of kallikrein hyperactivity, a sufficient amount of HMK. Provided the kallikrein content drops by 50%, the kininogenesis is reduced, which is accounted for by depletion of blood HMK. A 70%- and a greater decrease in the kallikrein content attests to the kininogenesis reduction because of the diminished levels of HMK, prekallikrein and kallikrein. The regularities described have been confirmed by the agreement between the blood plasma kallikrein level and the concentration of blood free kinins revealed during examination of 68 normal individuals and 231 patients suffering from different inflammatory-allergic diseases of the respiratory and hepatobiliary organs, and from diabetes mellitus.

Neomycin absorption following Clagett procedure for postpneumonectomy empyema.

Following a Clagett stage II procedure, significant amounts of neomycin are absorbed when concentrations of 0.25% neomycin (8.9 micrograms milliliter) are used. If higher concentrations are employed, the neomycin can achieve toxic levels (40 micrograms per milliliter), with associated renal toxicity and respiratory suppression. The peel of the empyema cavity does not prevent absorption of drugs. Therefore, when drugs are inserted into an empyema cavity, due care must be exerted to prevent drug toxicity.