The use of autologous supernatant of malignant pleura effusion in culturing human tumor infiltrating lymphocytes in vitro / 医学研究生学报

Objective:To study the effect of autologous supernatant of malignant pleura effusion and RPMI1640 with 10% AB+ serum on the culture of tumor infiltrating lymphocytes (TIL) in vitro. Methods:Isolated by the attachment method we established, TIL was cultured in either autologous supernatant of malignant pleura fluid or RPMI1640 with 10% AB+ serum, and various types of cytokines such as (IL-2,) PHA and antibody against CD3 (OKT3) were added into both cultures. The proliferation as well as the killing activity and the phenotype changes of TIL cultured in the two kinds of cultures were compared. Results:There was no difference in the proliferation or the killing activity in vitro as well as the phenotype changes of TIL between the two kinds of cultures. Conclusion: Autologous supernatant of malignant pleura fluid could be used as TIL culture medium. The method described here made it possible for TIL to be cultured in vitro for a short time, and then reinfused back to thorax for further expanding and controlling the malignant pleura effusion in the presence of IL-2, and it alsominimized the risks of contamination.

Appropriate dosage of interleukin-2 for tumor infiltrating lymphocyte cultured in self-supernatant of malignant pleura fluid / 医学研究生学报

Objective:To select an appropriate dosage of IL-2 for tumor infiltrating lymphocyte(TIL).Methods:Isolated by the attachment method we established,TIL was cultivated in self-supernatant of malignant pleura,with three different concentrations of IL-2,such as 6000u per ml,6000u per ml for the first administration followed by 1000u per ml,or 1000u per ml.The expansion,killing activity and phenotype changes of TIL cultured in different cultures were assessed.Results:As cultured in self-supernatant of malignant pleura fluid,the concentrations of IL-2,such as 6000u per ml or 6000u per ml for the first administration followed by 1000u per ml seemed benefit for TIL proliferation.Conclusion:6000u per ml of IL-2 for the first administration was very important.It could help TIL to activate and proliferate early.The study described here offers the possibility for TIL cultured in vitro self-supernatant of malignant pleura fluid in vitro for a short time,and then reinfuse to thorax for further expanding and controlling the malignant pleura effusion in the presence of IL-2,and thereby minimizing the risks of contamination.

Newly Appearing Tuberculous Pulmonary Masses during Antituberculous Treatment of Tuberculous Pleurisy: Radiographic and CT Findings

PURPOSE: To evaluate the imaging findings of tuberculous pulmonary masses developing during antituberculous treatment of tuberculous pleurisy. MATERIALS AND METHODS: The serial chest radiographs of 134 patients with tuberculous pleurisy were retrospectively assessed by two observers who recorded the presence of pulmonary masses observed on follow-up radiographs with their imaging findings. Four patients underwent chest CT scans. RESULTS: On chest radiographs, 29 masses were observed in 14 patients (10.4%) comprising seven men and seven women aged 21-52(mean, 33) years. The interval between the onset of pleurisy and the development of masses varied between 1 and 7 months. The lesions were single in nine patients and multiple in five; all developed in the hemithorax affected by pleurisy and 21 were located subpleurally. The CT scans obtained in four patients, demonstrated 14 masses in the peripheral lung. The location of ten of these was subpleural; eight of the ten showed extrapleural extension, and associated satellite nodules and ground-glass opacity were observed in six. Contrast-enhanced CT scans showed that enhancement pattern was peripheral in five, heterogeneous in five and homogeneous in four. Follow-up radiography indicated that all masses had become smaller. CONCLUSION: Tuberculous pulmonary masses may develop during antituberculous treatment of tuberculous pleurisy as single or multiple masses. Characteristically, a peripheral or subpleural pulmonary location is noted, and the CT findings include heterogeneous or peripheral rim enhancement, extrapleural extension and associated ground-glass opacity or satellite nodules.

Peripheral Bronchopleural Fistula: CT Evaluation in 22 patients

PURPOSE: To determine the usefulness of CT for the evaluation of peripheral bronchopleural fistulas. MATERIALS AND METHODS: CT scans of 22 patients with persistent air leak, as seen on serial chest PA, and aclinical history, were retrospectively evaluated. We determined the visibility of direct communication between thelung and pleural space, and the frequeucy and location of this, and if direct communications were not visualizedthe probable cause. RESULTS: A bronchopleural fistula(n=13) or its probable cause(n=6) was visualized in 19patients(86%). Direct communications between the lung and pleural space were seen in 13 patients(59%); there weresix cases of tuberculous empyema, three of tuberculosis, two of necrotizing empyema, one of trauma, and one ofpostobstructive pneumonitis. In six patients, bronchiectatic change in peripheral lung adjacent to the pleuralcavity was noted, and although this was seen as a probable cause of bronchopleural fistual, direct communicationwas invisible. Bronchopleural fistula or its probable cause was multiple in 18 of 19 patients, involving the upperand lower lobe in eight, the upper in nine, and the lower in two. CONCLUSIONS: CT is useful for evaluating thepresence of bronchopleural fistula, and its frequency and location, and in patients in whom the fistula is notdirectly visualized, the cause of this.

Delayed Enhancement of Pleural Effusion Following Angiography: A Case Report

It has been suggested that hyperdensity of pleural effusion, as seen on CT, is indicative of hemothorax. We report a case in which CT revealed delayed contrast enhancement of pleural effusion on, with no evidence of hemothorax. This phenomenon is clinically important because delayed enhancement can mimic hyperdensity of hemothorax.

Pancreaticopleural Fistula: CT Demonstration

In patients with chronic pancreatitis, the pancreaticopleural fistula is known to cause recurrent exudative or hemorrhagic pleural effusions. These are often large in volume and require treatment, unlike the effusions in acute pancreatitis. Diagnosis can be made either by the finding of elevated pleural fluid amylase level or, using imaging studies, by the direct demonstration of the fistulous tract. We report two cases of pancreaticopleural fistula demonstrated by computed tomography.

Pancreaticopleural Fistula: CT Demonstration

In patients with chronic pancreatitis, the pancreaticopleural fistula is known to cause recurrent exudative or hemorrhagic pleural effusions. These are often large in volume and require treatment, unlike the effusions in acute pancreatitis. Diagnosis can be made either by the finding of elevated pleural fluid amylase level or, using imaging studies, by the direct demonstration of the fistulous tract. We report two cases of pancreaticopleural fistula demonstrated by computed tomography.

Value of Ultrasound in the Determination of Drainage Methods in Patients with Tuberculous Pleural Effusion

PURPOSE: To evaluate the utility of ultrasonograpy(US) as a guide in deciding drainage methods and as a prognostic factor in the prediction of pleural fibrosis, and to compare the effects of drainage methods in patients with tuberculous pleural effusions. MATERIALS AND METHODS: In 51 patients with tuberculous pleural effusion, US patterns of pleural effusion were classified according to degree of septa into three groups, into three groups, as follows: anechoic (n=5), linear septa (n=15), and honeycombing septa (n=31). US-guided drainage methods, including thoracentesis (n=17), percutaneous catheter insertion (n=12), catheter insertion with urokinase instillation (n=22) were employed. Therapeutic effects were evaluated with follow-up chest radiographs after 3 and 6 months. RESULTS: Three months after the procedure, 43 of 51 effusions had drained effectively. US guided drainage failed in eight patients including two of six with linear septated effusion treated with thoracentesis, four of seven with honeycomb septated effusion treated with thoracentesis, and two of six with honeycombing septated effusion treated with catheter drainage. There was no drainage failure in patients with anechoic effusions and in patients with urokinase instillation. Late effects were assessed in 39 patients after 6 months. Follow-up radiographs available in 39 patients demonstrated pleural fibrosis with intercostal space narrowing in 7 patients with honeycomb septated effusion, 3 patients with linear septated effusion, and none of the patients with anechoic effusions. CONCLUSION: The pattern of septa seen on US could be a useful factor for determining drainage methods and predicting late results in tuberculous pleural effusion. Percutaneous catheter drainage with urokinase instillation was a good drainage modality for patients with septated pleural effusions. Pleural fibrosis is more frequently induced by septated pleural effusion than by anechoic pleural effusion.

Distribution of Pleural Effusion Associated with Ascites on Abdominal CT

PURPOSE: To determine through an analysis of the location of pleural effusion associated with ascites, as seen on abdominal CT scan, differences in the distribution of pleural effusion according to the etiology and distribution of ascites. MATERIALS AND METHODS: We retrospectively evaluated 77 consecutive patients in whom abdominal CT scan revealed pleural effusion associated with ascites. Patients with history of surgery or trauma and those with clinically and radiologically diagnosed lung or pleural diseases were excluded. We compared the location of pleural effusion with the etiology and distribution of ascites. RESULTS: Forty-two patients were suffering from hepatobiliary diseases, mainly right dominant pleural effusion (26/42, 62%). Fourteen had intraperitoneal carcinomatosis with no significant difference between the frequency of right dominant (5/14, 36%)and of left dominant (6/14, 43%) pleural effusion. Eleven patients had pancreatic diseases, with mainly left dominant pleural effusion (6/11, 55%). Patients with right dominant ascites usually had right dominant pleural effusion (22/24, 92%) and those with left dominant ascites had left dominant pleural effusion (9/10, 90%). CONCLUSION: Ascites-associated pleural effusion correlated with the anatomical location of the etiology of ascites ; its laterality was, in addition, usually the same as that of ascites.

Differentiation of Exudative and Transudative Pleural Effusion: MR Appearances

PURPOSE: The purpose of this study is to determine whether MR images after intravenous administration of Gd-DTPA can differentiate exudative and transudative pleural effusion. MATERIALS AND METHODS: We studied 18 patients with ten exudative and eignt transudative pleural effusions diagnosed clinically and by thoracentesis. We analysed the relationship between T1 value(normalized to fat) and the ratio of effusion/serum protein of pleuraleffusion. We also assessed the contrast enhancement of exudative and transudative pleural effusion on T1 weighted SE images taken at 15 and 30 minutes after administration of Gd-DTPA. RESULTS: The relationship between the effusion/serum protein ratio and T1 value(normalized to fat) was statistically not significant(r=0.27, P=0.381).On precontrast spin-echo T1W1, mean signal intensity of the transudate was 0.18 (+/-0.04) and that of the exudatewas 0.24(+/-0.07), values which were not significant differences(P>0.05). Postcontrast mean signal intensities of transudates at 15 and 30 were 0.20+/- 0.06 and 0.26+/-0.08, respectively, values which were not significantly higherthan that of precontrast mean signal intensity(P<0.05). Postcontrast mean signal intensity values of exudative pleural effusions at 15 and 30 mimutes(0.32+/-0.06 and 0.39+/-0.06, respectively) were, on the other hand, significantly higher than that of precontrast mean signal intensity(P<0.05). CONCLUSION: Postcontrast T1-weighted SE images at 15 and 30 minutes can be helpful in the differentiation of transudative and exudative pleural effusion.

Enhanced CT in the Patients with Pleural Effusion: Differential Findings between Exudates and Transudates

PURPOSE: To evaluate the differential findings of CT in the differention of pleural exudates and transudates. MATERIALS AND METHODS: One hundred and thirteen consecutive patients (113 effusions) underwent enhanced thoracic CT ; the scans were evaluated for the presence or absence and appearance of enhancing parietal pleural thickening and extrapleural fat thickening. Thoracentesis was performed to measure pleural and serum total protein andlactate dehydrogenase(LDH) values. Effusions were classified as exudates by using Light's criteria. RESULTS: Eighty-eight effusions were exudates and 25 were transudates. Eighty-three of the 88 exudates (93%) were associated with enhanced parietal pleural thickening ; seventy of the 88 (80%) were associated with extrapleural fat thickening. Four of the 25 transudates were associated with parietal pleural thickening and extrapleural fat thickening, both of which were the most important factors in differentiating beteen pleural exudates and transudates(p<0.05). CONCLUSION: Parietal pleural thickening and extrapleural fat thickening on contrast-enhanced CT almost always in dicate the presence of pleural exudates.