Epidemiologic evaluation of pleurisy diagnosed by surgical pleural biopsy using data from a nationwide administrative database.

BACKGROUND: Pleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video-assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large-scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database. METHODS: We evaluated Japanese Diagnosis Procedure Combination data of 24 173 patients who underwent video-assisted thoracoscopic surgery or open thoracotomy and received a diagnosis of pleurisy between April 2014 and March 2020. In addition to pleurisy diagnoses, the patients' clinical information, including age, sex, smoking status (pack-years), dyspnea grade, length of in-hospital stay, and comorbidities, were extracted from the dataset. RESULTS: This study included data from 1699 patients. The most frequent causes of pleurisy were neoplastic diseases (55.9%; malignant mesothelioma 22.5%, lung cancer 15.7%, lymphoma 2.5%), followed by infectious diseases (24.0%; tuberculosis 16.2%, parapneumonic pleural effusion 3.6%, empyema 3.5%, nontuberculous mycobacteriosis 0.5%), collagen vascular diseases (2.8%; rheumatoid arthritis 1.3%, immunoglobulin G4-related diseases 0.7%, systemic lupus erythematosus 0.3%), and paragonimiasis (0.1%). CONCLUSIONS: Neoplastic diseases, including malignant mesothelioma and lung cancer, were frequently and accurately diagnosed as pleurisy via surgical pleural biopsy. The next leading cause was infectious diseases such as mycobacterial infections. Physicians should consider performing surgical biopsy in light of the knowledge regarding the etiology of pleurisy when a definitive diagnosis cannot be made via needle pleural biopsy.

Pleuritis and Pericarditis in Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis.

BACKGROUND: Pleural and pericardial involvements are well recognized in eosinophilic granulomatosis with polyangiitis (EGPA) but considered rare manifestations of the other forms of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). RESEARCH QUESTION: What are the frequency and clinical characteristics of pleuritis and pericarditis in AAV? STUDY DESIGN: and Methods: Using an institutional database of 1,830 patients with AAV, we analyzed clinical notes and diagnosis codes for key words related to pleuritis and pericarditis. Chart review to confirm these findings was performed. RESULTS: Eighty-eight of 1,058 patients (8.3%) with granulomatosis with polyangiitis (GPA), 27 of 267 (10.1%) with microscopic polyangiitis (MPA), and 35 of 201 (17.4%) with EGPA had a manifestation of pleuritis and/or pericarditis attributable to vasculitis. There was a higher frequency of pericarditis in EGPA compared with that in the other AAVs (P < .01). There was no difference in the frequency of pleuritis in GPA, MPA, or EGPA. In the 156 patients with AAV with pleuritis and/or pericarditis, this was a presenting feature in 127 (81.4%). Overall, it was a presenting feature in 6.9% of all patients with AAV, including 6.5% with GPA, 8.6% with MPA, and 15.9% with EGPA. INTERPRETATION: Pleuritis and pericarditis occur across all the AAVs and, when present, are commonly presenting features of these diseases. Patients with EGPA have a higher proportion of pericardial involvement compared with pleural involvement, whereas this distribution is more equal in patients with GPA and MPA. Pleuritis and pericarditis are underrecognized features of AAV. All forms of AAV should be considered in the differential diagnosis when evaluating a patient with pleuritis or pericarditis.

Clinical characteristics and social productivity levels of patients with malignant rheumatoid arthritis based on a nationwide clinical database in Japan: annual survey from 2003 to 2013.

OBJECTIVES: Malignant rheumatoid arthritis (MRA) is defined as rheumatoid arthritis (RA) with systemic vasculitis or other severe extra-articular manifestations. Japan has a nationwide database for MRA. We analyzed the characteristics of Japanese patients with MRA based on data from the Ministry of Health, Labour and Welfare (MHLW). METHODS: We were permitted to use data on 43,108 patients who were registered in the MHLW database from 2003 to 2013. RESULTS: Median age was 65 (interquartile range, 57-72) years. Patients consisted of 71% females. Proportions of patients who had or had experienced interstitial pneumonia and pleuritis were increased, episcleritis was stable, and other MRA manifestations were decreased over time. The number of positive symptoms per patient also decreased over time. The median dose of glucocorticoid, percentage of patients undergoing surgery, and use of non-steroidal anti-inflammatory drugs and apheresis decreased year by year. Steinbrocker stage and class improved over time. Median C-reactive protein levels and erythrocyte sedimentation rate also decreased. Regarding social productivity levels of patients with MRA, the proportion of patients who were working or working from home increased and the proportion of patients recuperating or hospitalized decreased. CONCLUSION: In patients with MRA, disease activity decreased and social productivity improved from 2003 to 2013.

Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy.

BACKGROUND: Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently available methods, such as the detection of acid-fast bacilli and microbiological culture, are not always conducive to timely diagnosis and treatment. In this study, we evaluated the performance of Xpert® MTB/RIF assay (hereinafter referred to as "Xpert") in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens obtained under direct thoracoscopic guidance. METHODS: One hundred and sixty patients with an unexplained pleural effusion were included from the Shenyang Tenth People's Hospital and Shenyang Chest Hospital, China, between 2017 and 2018. The included patients underwent thoracoscopy under local anesthesia, with an intercostal incision of approximately 1.0 cm for biopsy. The biopsy specimens were used for pathological and etiological examinations. The Xpert test was evaluated for its sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV, respectively), against data obtained using standards: the BACTEC™ MGIT™ 960 liquid culture system and a composite reference standard (CRS). RESULTS: The sensitivity and specificity of Xpert were 68.8 and 64.6%, respectively, against the MGIT 960 culture data. The PPV and NPV of Xpert were 56.4 and 75.6%, respectively. The sensitivity of Xpert was 69.0% against the CRS data, which was significantly higher than that of MGIT 960 culture (56.6%). The PPV and NPV of Xpert against the CRS data were 100.0 and 57.3%, respectively. CONCLUSIONS: Xpert is a good rule-in test but has limited value as a rule-out test for the diagnosis of tuberculosis pleuritis.

High Occurrence of Thrombo-Embolic Complications During Long-Term Follow-up After Pleural Infections-A Single-Center Experience with 536 Consecutive Patients Over 17 Years.

PURPOSE: Pleural infections are associated with significant inflammation, long hospitalizations, frequent comorbidities, and are often treated operatively-all of which are consequential risk factors for thrombo-embolic complications. However, their occurrence following the treatment of pleural infection is still unknown. The aim of the study was to ascertain the early and long-term occurrence of thrombo-embolic events in patients treated for pleural infections. METHODS: The study included all patients that were treated for pleural infections in Tampere University Hospital between January 2000 and December 2016. Data regarding later treatment episodes due to pulmonary embolisms and/or deep vein thromboses as well as survival data were requested from national registries. The rates were also compared to a demographically matched reference population adjusted for age, sex, and the location of residence. RESULTS: The final study population comprised 536 patients and 5318 controls (median age 60, 78% men). The most common etiology for pleural infection was pneumonia (73%) and 85% underwent surgical treatment for pleural infection. The occurrence of thrombo-embolic complications in patients and controls was 3.8% vs 0.1% at three months, 5.0% vs 0.4% at one year, 8.8% vs 1.0% at three years, and 12.4% vs 1.8% at five years, respectively, p < 0.001 each. Female sex, advanced age, chronic lung disease, immunosuppression, video-assisted surgery, and non-pneumonic etiology were associated with a higher incidence of thrombo-embolism. CONCLUSIONS: The occurrence of thrombo-embolic events-particularly pulmonary embolism but also deep vein thrombosis-was significant in patients treated for pleural infections, both initially and during long-term follow-up.

The Incidence of Hemorrhagic Complications Was Lower With the Guide Sheath Than With the Conventional Forceps Biopsy Method: Results of Bronchoscopy in the 2016 Nationwide Survey by the Japan Society for Respiratory Endoscopy.

BACKGROUND: The Japan Society for Respiratory Endoscopy performed a nationwide survey to evaluate the current status and complications of bronchoscopy. Data on deaths due to bronchoscopy, complications after bronchoscopy, and particularly, complications of forceps biopsy were surveyed. METHODS: The survey form was mailed to 532 facilities accredited by the society. The numbers of procedures, complications, and deaths were investigated. RESULTS: The response rate was 79.1% (421 facilities). Deaths attributable to diagnostic bronchoscopy occurred in 11 (0.011%) of 98,497 cases.In regards to forceps biopsy, the guide sheath method was applied in 23,916 cases and the conventional method in 31,419 cases was done with conventional method. Complications of forceps biopsy developed in 1019 cases in total, with an incidence rate of 1.84%. The most frequent complication was pneumothorax (0.70%), followed by pneumonia/pleurisy (0.46%) and hemorrhage (0.45%). The incidence of hemorrhagic complication was significantly lower in the guide sheath group than in the non-guide sheath group (0.29% vs. 0.58%; P<0.001). The overall incidence of complications (1.63% vs. 2.00%; P=0.002) and the mortality rate (0% vs. 0.02%; P=0.04) were significantly lower in the guide sheath group. CONCLUSION: The incidence of hemorrhagic complications in forceps biopsy of peripheral pulmonary lesions was lower when the guide sheath method was applied. It is necessary to increase the awareness for safety control in diagnostic bronchoscopy for new procedures.

What is the significance of non-specific pleuritis? A trick question.

Non-specific pleuritis (NSP) is defined as fibrinous or inflammatory pleuritis which cannot be attributed to a specific benign or malignant etiology. It can be diagnosed in biopsies in up to 30% of cases of exudative pleuritis after thoracoscopy, with a mean of 19.2%. In 66 out of 469 (14.2%) patients in combined series, a malignant pleural disease (mostly mesothelioma) was found during a follow-up of at least 21 months. Most likely, a follow-up time of 12 months is sufficient, although the current routine is a follow-up of 2 years. Because of a benign course in 85% of patients with NSP, a repeated invasive procedure after thoracoscopy is only indicated in a limited group of patients. The most important indications for a repeated pleural biopsy are persistent chest pain, recurrent pleural effusion, radiologic findings suggestive for malignant pleural disease.

Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience.

BACKGROUND AND OBJECTIVE: Malignant pleurisy is associated with advanced oncological disease and dyspnoea is the most common presenting symptom. Pleurodesis is the preferred palliative and supportive treatment option, targeting symptom relief. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making. METHODS: All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included. Univariate and multivariate analyses were performed to identify factors associated with successful pleurodesis. RESULTS: Of the 155 patients, 122 (78%) were classified as having a successful pleurodesis based on clinical and radiological criteria. Factors associated with unsuccessful pleurodesis (univariate analysis) were the presence of pleural adhesions (odds ratio (OR): 0.43 (95% CI: 0.19-0.96); P = 0.04), extensive spread of pleural lesions (OR: 0.17 (95% CI: 0.05-0.59); P = 0.001), the use of systemic corticosteroids (OR: 0.28 (95% CI: 0.10-0.83); P = 0.02) and a prolonged time period between the clinical diagnosis of the pleural effusion and the moment of pleurodesis (OR: 0.14 (95% CI: 0.06-0.32); P < 0.0001). The latter being associated with failure of pleurodesis in a multivariate analysis (OR: 0.08 (95% CI: 0.01-0.25); P < 0.0001). Chest ultrasound prior to pleurodesis showed a sensitivity of 91% and a specificity of 88% in predicting the success of pleurodesis. CONCLUSION: The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and early referral for pleurodesis. Ultrasonic assessment of pleural adhesions and potential lung expansion prior to pleurodesis is useful in clinical decision-making.

Severe Extraarticular Manifestations in a Community-based Cohort of Patients with Rheumatoid Arthritis: Risk Factors and Incidence in Relation to Treatment with Tumor Necrosis Factor Inhibitors.

OBJECTIVE: The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA. METHODS: A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA. RESULTS: During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41-1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54-0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60-1.78). The age- and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21 (95% CI 1.02-1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA. CONCLUSION: This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.

Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery.

OBJECTIVE: The aim of this study was to develop a perioperative metastatic spinal tumor frailty index (MSTFI) that could predict morbidity, mortality, and length of stay. METHODS: A large inpatient hospitalization database was searched from 2002 to 2011 to identify 4583 patients with spinal metastasis from breast (21.1%), lung (34.1%), thyroid (3.8%), renal (19.9%), and prostate (21.1%) cancer who underwent surgery. A multiple logistic regression model identified 9 independent parameters that were used to construct the MSTFI: anemia, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, emergent/urgent admission, and anterior/combined surgical approach. Patients with 0 points were categorized as "not frail," 1 as "mildly frail," 2 as "moderately frail," and ≥3 as "severely frail." RESULTS: The overall perioperative complication rate was 19.3% and in-patient mortality was 3.0%. Compared with patients with no frailty, patients with moderate frailty (odds ratio [OR] 5.15; 95% confidence interval [95% CI] 2.44-10.86), and severe frailty (OR 5.74; 95% CI 2.69-12.24) had significantly increased odds of inpatient mortality (all P < 0.001). Similarly, patients with mild frailty (OR 1.88; 95% CI 1.33-2.66), moderate frailty (OR 3.83; 95% CI 2.71-5.41), and severe frailty (OR 6.97; 95% CI 4.98-9.74) had significantly increased odds of developing a major in-hospital complication (all P < 0.001). Length of stay also increased significantly by MSTFI (P < 0.001). CONCLUSIONS: In surgically treated patients with spinal metastasis, certain perioperative parameters may significantly predict the risk of major in-hospital complications and mortality.

Pleural fluid tests to diagnose tuberculous pleuritis.

PURPOSE OF REVIEW: This article summarizes current data regarding the accuracy of pleural fluid tests assisting the diagnosis of tuberculous pleuritis (TBP). RECENT FINDINGS: No pleural fluid test reliably rules-in TBP in settings with low TBP prevalence. Interferon-γ) alone or in combination with adenosine deaminase (ADA) is more reliable than ADA for this purpose in nonlow prevalences. ADA can reliably rule-out TBP in prevalences of less than 40% although in higher prevalences the product of interleukin-27 and ADA is the most accurate rule-out test. SUMMARY: The definite diagnosis of TBP requires the isolation of Mycobacterium tuberculosis from pleural fluid or biopsies. Because of the low sensitivity of pleural fluid cultures and the invasiveness of pleural biopsy techniques, the concept of a pleural fluid test that accurately establishes or excludes TBP diagnosis has been proposed. Numerous pleural fluid tests have been evaluated for this purpose with ADA being the most widely accepted one. During the last years, it has been demonstrated that the ability of ADA to rule-in or rule-out TBP is affected by the prevalence of TBP in the setting where the test is used. The complementary use of interferon-γ or interleukin-27 increases the ability of ADA to rule-in or rule-out the disease, respectively.

Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation.

BACKGROUND: Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study's objective is to determine if IPC insertion is safe in patients undergoing chemotherapy. METHODS: We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications. RESULTS: One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3%) vs 3 (4.9%) respectively, was not statistically different (Fisher's exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007). CONCLUSIONS: This is the second largest retrospective case-control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.

Epidemiological evaluation of the outcomes after video-assisted thoracoscopic talcage in neoplastic pleurisy.

AIM: Clinical-epidemiological investigations for further assessing the importance of video-assisted thoracoscopy in the treatment y of patients with neoplastic pleurisy. MATERIALS AND METHODS: The researches included a group of 72 patients (31.9% men and 68.1% women aged 31-81 years, mean age ± 60 years) with neoplastic pleurisy who underwent pleural symphysis by video-assisted thoracoscopic talcage. For statistical-mathematical processing and interpretation the Pearson correlation index with the level of significance at p = 0.05 and highly significant at p < 0.005 was used. RESULTS: Neoplastic pleurisy prevalently affected the age groups 51-80 years (84.9%). Dyspnea was present in all cases, and patient history at the time of admission revealed 14 conditions, of which 25% were lung cancers. Macroscopically nodular and vegetative tumors were found in 66.7% of cases. An amount of 1000-2000 ml of pleural fluid was found in 44.5% of the cases and a serocitrin appearance in 50%. In 23.6% of the cases cytology results were positive for malignancy and in 13.8% suspicious. In 65.2% of the cases the pleural fluid was exudative and anatomopathology was suggestive of adenocarcinoma in 34.7% of the cases and breast cancer in 18%. The prevalence of recurrences varied from 1 month to more than 7 months, with 36.4% for 1-2 months. CONCLUSIONS: The obtained additional data support the important role of pleural symphysis by video-assisted thoracoscopic talcage in the patients with neoplastic pleurisy.

Etiologies and outcomes of pleural effusions in patients with systemic lupus erythematosus.

BACKGROUND: Pleuritis is the most common pulmonary manifestation in systemic lupus erythematosus (SLE). In Thailand, the incidence of tuberculosis (TB) is high; moreover, treatment with immunosuppressive agents increases the risk for TB infection. OBJECTIVE: The objective of this study was to examine the clinical manifestations, etiology, management, and outcomes of patients with SLE and pleural effusion in an area for TB. METHODS: We studied adults satisfying the American College of Rheumatology classification criteria for SLE who presented with pleuritis between 2002 and 2010. Pleuritis was defined as having 1 of 3 of the following criteria: typical pleuritic chest pain, pleural rub, and clinical or radiological evidence of pleural effusion. RESULTS: A total of 119 patients with 127 episodes of pleuritis/pleural effusion were included. Pleuritis was the first presentation in 47 episodes (37%) and was found accompanied with pericarditis for 16%. Most patients (81%) had active SLE in other systems. The causes of pleural effusion included lupus pleuritis (52%), tuberculous pleuritis (9%), parapneumonic effusion (7%), and transudate (15%). The diagnosis was inconclusive in 17%. The diagnosis of lupus pleuritis was made by a clinical diagnosis (47%) and by excluding other causes from pleural fluid analysis or biopsy (53%). Most patients with lupus pleuritic responded well to corticosteroid therapy. CONCLUSIONS: Lupus pleuritis is still the most common cause of pleural effusion in SLE and often reflects its disease activity. The diagnosis of lupus pleuritis is a clinical diagnosis or is performed by excluding other conditions. The treatment outcomes of lupus pleuritis are generally good.

[Pulmonary and pleural complications of the descending aorta surgery].

The experience of surgical treatment of 84 patients with diseases of the descending thoracic aorta was analyzed. Frequency and structure of pleura-pulmonary complications after reconstructive surgery of the descending aorta were thoroughly registered. 58.3% of the operated patints developed complications. The most frequent complication was the acute respiratory insufficiency in early postoperative period (29.76% of patients).

Extra-articular manifestations in a community-based sample of patients with rheumatoid arthritis: incidence and relationship to treatment with TNF inhibitors.

OBJECTIVES: To determine the incidence of severe extra-articular rheumatoid arthritis (ExRA) in a community-based cohort of RA patients, and to evaluate whether treatment with tumour necrosis factor (TNF) inhibitors has any effect on the risk of ExRA. METHODS: In a review of clinical records from 1 July 1997 to 31 December 2004, severe ExRA manifestations were classified according to predefined criteria. Patients were censored at the development of ExRA, death, emigration, or 31 December 2004. Exposure to anti-TNF treatment has continuously and independently been recorded as part of a regional follow-up system. RESULTS: During treatment with TNF inhibitors, there were two patients with new onset of ExRA in 408 person-years at risk (pyr) [0.49/100 pyr, 95% confidence interval (CI) 0.06-1.77]. Among those without anti-TNF treatment there were 63 patients with ExRA in 5425 pyr (1.16/100 pyr, 95% CI 0.89-1.49). The relative risk comparing those treated to those not treated with TNF inhibitors was 0.42 (95% CI 0.10-1.73). CONCLUSION: Our data show a lower incidence of ExRA in patients treated with TNF inhibitors but further studies with a larger sample size are needed for a more accurate estimate of the size of the effect.

Sex differences in disease severity among patients with systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE), a prototypical autoimmune disease, often results in comorbidities from exposure to medications as well as from chronic inflammation. Identification of gender-based differences in comorbidities and disease severity may assist health practitioners in providing optimum care for those living with SLE. OBJECTIVE: The purpose of this study, which utilized hospital discharge data collected during a 7-year period to garner a large SLE patient sample, was to determine the effect of gender on SLE comorbidities and disease severity. METHODS: Patients were hospitalized in the Dallas-Fort Worth metropolitan statistical area between 1999 and 2005 and had a diagnosis of SLE. The sample consisted of 14,829 patients with SLE, 10% of which were male. ANOVAs were conducted to test for differences between males and females for disease severity, age, length of stay in the hospital, total hospital charges, and number of autoimmune diseases. Disease severity was measured with the SLE comorbidity index, which weights 14 conditions in SLE. We identified the top 30 comorbidities as well as the odds of experiencing the secondary illnesses by gender. RESULTS: Male patients had significantly greater disease severity compared with female patients. Additionally, female patients had more autoimmune diagnoses compared with male patients. Male patients were more likely to have cardiovascular and renal comorbidities compared with female patients. Female patients had significantly greater odds of diagnoses of urinary tract infection, hypothyroidism, depression, esophageal reflux, asthma, and fibromyalgia. CONCLUSIONS: Although the prevalence of SLE among males is rare, male patients have the potential for greater disease severity and are more likely to suffer from cardiovascular and renal disease. Gender differences in disease severity should be further evaluated, but with the added recommendation to develop an index with conditions more indicative of active SLE.

[Pleural puncture biopsy in the aetiological diagnosis of pleurisy]. / Ponction biopsie pleurale dans le diagnostic étiologique des pleurésies.

INTRODUCTION: Pleurisy represents a worrying situation because of the difficulty of aetiological diagnosis. The aim of this study was to evaluate the contribution of pleural puncture biopsy (PPB) in the diagnosis of pleurisy. METHODS: A prospective study of the contribution of the pleural puncture biopsy in the pulmonary service of Bamako (Mali) from 2005 to 2009. PPB was used in the investigation of exudative, non-purulent pleurisy of unknown aetiology. Castelin biopsy forceps were used. RESULTS: Pleurisy was the reason for 20% of the total admissions of 6374 patients. The PPB was performed in 390 patients or 30.6% of the cases of pleurisy. The HIV test was performed in 341 patients (87.4%), of whom 72 cases (21.1%) were positive. The pleural biopsies were: lymphocytic (68.7%), mixed cellular (17.1%). Histological interpretation was possible in 367 biopsy specimens, a yield of 94.1%. Tuberculous granulomata were found in 65.1% with a close relationship to HIV status (P<0.004). Pleural cancer was found in 16.1%. CONCLUSION: The PPB is easy to perform at a low cost. It permits the diagnosis of tuberculous and neoplastic pleurisy, particularly in low income countries with a high prevalence of TB/HIV.

[Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. / Incidence de la maladie thromboembolique veineuse chez des hommes admis dans un service de pneumologie pour affection respiratoire aiguë

BACKGROUND: Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD: The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS: Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION: VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.

[Asbestos-related diseases in a population near a fibrous cement factory]. / Enfermedad por amianto en una población próxima a una fábrica de fibrocemento.

BACKGROUND AND OBJECTIVE: The first fibrous cement factory in Spain was set up in Cerdanyola, Barcelona, in 1907 and was a source of pollution there until it was closed in 1997. The aim of this study was to determine the clinical and epidemiologic characteristics of the population with by asbestos-related diseases who had worked in the factory and/or lived in the vicinity. MATERIAL AND METHODS: We retrospectively collected information available on patients with asbestos-related diseases who at the time of diagnosis had resided in the area near the fibrous cement factory. Information was obtained from the medical records of the primary care centers of the 12 surrounding towns and the sole referral hospital in the area for cases diagnosed between January 1, 1970 and December 31, 2006. RESULTS: In the 559 patients diagnosed, 1107 cases of asbestos-related diseases were identified. Between 2000 and 2006, the average annual incidence was 9.5 cases per 100,000 inhabitants for the entire study area and 35.5 cases per 100,000 for the area nearest the factory. The prevalence of asbestos-related diseases as of December 31, 2006 was 91 cases per 100,000 inhabitants in the entire study area and 353.4 cases per 100,000 in the area nearest the factory. Of the 1107 asbestos-related disease cases identified, 86.5% were benign and 8.4% pleural mesothelioma. CONCLUSIONS: The factory introduced an important area-wide risk factor for asbestos-related diseases for both workers and for the nearby population. The number of cases of asbestos-related diseases detected annually showed an upward trend. The incidence was extremely high in the period studied.