Effectiveness and safety of local anesthetic, semi-flexible pleuroscopy - experience from a peripheral hospital.

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.

Diagnosis of drowning by summation of sodium, potassium and chloride ion levels in pleural effusion: differentiating between freshwater and seawater drowning and application to bathtub deaths.

Although electrolyte analysis of pleural effusion at autopsy is useful for the diagnosis of water aspiration (i.e., drowning), the method of comparing each level of sodium (Na(+)), potassium (K(+)), and chloride (Cl(-)) ions does not clearly differentiate between freshwater drowning, seawater drowning, and non-drowning. Therefore, here we introduce the summation of Na(+), K(+), and Cl(-) levels, that is SUM(Na+K+Cl), as a modified diagnostic indicator. In 21 autopsy cases of freshwater drowning, 32 cases of seawater drowning, and 43 non-drowning controls (with pleural effusion), mean SUM(Na+K+Cl) differed significantly between the groups (188.8±33.2, 403.5±107.9, and 239.3±21.7 mEq/L, respectively). We defined a SUM(Na+K+Cl) cut-off value of <195.9 mEq/L as strongly suggestive of freshwater aspiration and that of >282.7 mEq/L as strongly suggestive of seawater aspiration. When these values were applied to the two drowning groups, 15 cases (71%) of freshwater drowning and 29 cases (91%) of seawater drowning were diagnosed correctly. This new approach may be more valid than previous methods in cases found >2 days after death or those with substantial pleural effusion (>100 mL). For an additional 15 bathtub deaths, mean SUM(Na+K+Cl) was 198.8±40.0 mEq/L, and in 14 of these cases (93%) the relationship between cause of death and SUM(Na+K+Cl) could be explained using this method. Forensic pathologists should not depend exclusively on chemical findings and should consider also typical pathological indicators of drowning. This new method may be useful as a supplementary diagnostic tool when used alongside consideration of the pathological findings.

Triggering receptor expressed on myeloid cell 1.

Sepsis is a common cause of morbidity and mortality in intensive care units. There is no gold standard for diagnosing sepsis because clinical and laboratory signs are neither sensitive nor specific enough and microbiological studies often show negative results. The triggering receptor expressed on myeloid cell 1 (TREM-1) is a member of the immunoglobulin superfamily. Its expression is upregulated on phagocytic cells in the presence of bacteria or fungi. This article reports on the potential usefulness of the assessment of the soluble form of TREM-1 in biologic fluids in the diagnosis of infection.

Tentative fingerprint-efficacy study of Houttuynia cordata injection in quality control of traditional Chinese medicine.

To establish potent fingerprint for quality control of traditional Chinese medicine, Houttuynia cordata (Saururaceae) injection (HCI), the attempt on fingerprint-efficacy was developed in this study. HCI from ten different factories were determined by gas chromatography-mass spectrum (GC-MS) and classified by hierarchical clustering. The anti-inflammatory effect of HCI was characterized with the rat pleurisy model induced by carrageenin and the mice ear edema model by xylene. The results showed that anti-inflammatory effect of the injections from most of factories on the two models was significant. There was corresponding relationship between the fingerprint of HCI and efficacy to certain extent. The main common constitutes in injection from the factories that possess anti-inflammatory activity were analysed with GC-MS and identified using the NIST Mass Spectral Database. This common pattern of HCI based on the efficacy was helpful for the purpose of quality control.

[Effects of the volatile oil of Centipeda minima on acute pleural effusion in rats induced by an intrapleural injection of car].

OBJECTIVE: To study the anti-inflammation effect of volatile oil of Centipeda minima and the mechanism of action. METHOD: The animal model was induced by the Car injection into intrapleural of rats, to observe the effect of VOCM on acute inflammation. RESULT: VOCM was able to inhibit the increase of NO, CRP and proinflammatory cytokines such as TNFalpha in the acute inflammation of the rat body. CONCLUSION: VOCM has a protective effect on acute pleural effusion in rats induced by an intrapleural injection of Car.

Lipid mediator class switching during acute inflammation: signals in resolution.

Leukotrienes (LTs) and prostaglandins (PGs) amplify acute inflammation, whereas lipoxins (LXs) have unique anti-inflammatory actions. Temporal analyses of these eicosanoids in clinical and experimental exudates showed early coordinate appearance of LT and PG with polymorphonuclear neutrophil (PMN) recruitment. This was followed by LX biosynthesis, which was concurrent with spontaneous resolution. Human peripheral blood PMNs exposed to PGE2 (as in exudates) switched eicosanoid biosynthesis from predominantly LTB4 and 5-lipoxygenase (5-LO)-initiated pathways to LXA4, a 15-LO product that "stopped" PMN infiltration. These results indicate that first-phase eicosanoids promote a shift to anti-inflammatory lipids: functionally distinct lipid-mediator profiles switch during acute exudate formation to "reprogram" the exudate PMNs to promote resolution.

Reduced inflammatory response in rats fed fat-rich diets: role of leukotrienes.

The effect of fat-rich diets on the acute inflammatory response was examined. Male Wistar rats aged 21 days were fed, for 6 weeks, with a control diet (4% fat content), or a control diet supplemented with coconut or soybean oils (15% fat content). Carrageenan-induced paw oedema and pleurisy were evaluated. Prostaglandin (PG) E2 and leukotriene (LT) C4/D4 concentrations were determined in the pleural exudate (ELISA). Pleural samples were tested for their effect on cutaneous vascular permeability of control rats and the effect of a LTD4 receptor antagonist (L660-711; 10 mg/kg; i.v.) examined. Relative to controls, rats fed both fat-rich diets presented a significant reduction in protein leakage and oedema formation without affecting the number of migrating leukocytes. Production of LTC4/D4 in pleural exudate was significantly increased from 1.8 +/- 0.2 ng/ml in controls to 2.8 +/- 0.2 and 3.0 +/- 0.3 ng/ml in animals fed coconut and soybean oil enriched diets, respectively, without changes in PGE2 production. The activity of these samples on cutaneous vascular permeability was 50% reduced, returning to control values after treatment of testing animals with a LTD4 receptor antagonist. Rats fed fat-rich diets presented a reduced inflammatory response due, at least in part, to the LTC4/D4 mediated vasoconstrictor effect.

Pleural effusions and sera from patients with benign or malignant diseases.

In pleural effusions and sera from 66 patients copper and zinc were quantified by inductively coupled argon plasma-mass spectrometry after mineralizations in a closed-pressurized microwave unit with a mixture of concentrated nitric acid and 30% hydrogen peroxide. Total protein, pH, leukocyte count, lactate dehydrogenase, glucose, C-reactive protein, ceruloplasmin, and alpha1-antitrypsin were determined in many of the effusions. All but four effusions had concentrations of copper (range 58-1720 microg/kg) and zinc (range 27-1001 microg/kg) that were lower than the concentrations in the corresponding sera. Very high concentrations of zinc (1930-6470 microg/kg) were characteristic for thoracic empyemata. In the scatterplots of serum copper versus effusion copper, serum zinc versus effusion zinc, and serum copper/effusion copper versus serum zinc/effusion zinc no clearly delineated regions were noticeably useful for identifying malignant effusions. Similar plots of the concentrations of copper or zinc versus the eight clinical laboratory parameters or plots of clinical parameter versus clinical parameter failed to be of diagnostic value. Statistically highly significant correlations (p < or = 0.05, n > 45, r2 > 0.25) were observed for 9 of 28 pairs of the clinical parameters, for total protein and copper in the effusions and zinc in the effusions and for ceruloplasmin and copper in the effusions. Among the patients suffering from benign or malignant effusions, 52% had zinc concentrations in the sera below the low limit of the normal range (600 microg/kg). Supplementation of such patients with zinc should be considered.

Concentrations of copper, zinc, manganese, rubidium, and magnesium in thoracic empyemata and corresponding sera.

In this study, a number of selected trace elements and clinically relevant parameters were compared between thoracic empyemata and the corresponding sera for a better understanding of the trace element distribution between these two compartments. Serumempyema pairs were obtained from 13 patients and quantified for selected and essential trace elements, namely copper (Cu), zinc (Zn), manganese (Mn), rubidium (Rb), and magnesium (Mg), by inductively coupled plasma-mass spectrometry (ICP-MS). In addition, the concentrations of the following clinical laboratory parameters were analyzed by standard methods: total protein, leukocyte count, lactate dehydrogenase, glucose, pH, and the C-reactive protein. Individual concentrations of the elements determined in the empyemata were frequently higher than in pleural effusions of any other benign or malignant condition except for Cu. Serum Cu exceeded the normal range (600-1400 microg/kg) in 6 out of 13 patients (median 1410 microg/kg). In the empyemata, Zn concentrations (median 2000 microg/kg) were characteristically higher than in the sera (median 450 microg/kg) and exceeded the upper limit for serum (1200 microg/kg) in 8 of the 13 patients. Manganese concentrations in the empyemata (median 2.7 microg/kg) were also higher compared to corresponding sera, although they stayed within the limits considered normal for serum of healthy adults (upper limit 2.9 microg/kg). Rubidium was also moderately higher in most empyemata (median 290 microg/kg) and exceeded the upper limit for serum (560 microg/kg) in two patients. The median concentration of the essential element magnesium was higher in the empyemata (23 mg/kg) than in the sera (21 mg/kg). However, all serum Mg concentrations except three remained within the normal range (17-22 mg/kg). Removal of large amounts of empyematous fluid may deprive the body of trace elements and can cause suboptimal or deficient trace element status and homeostasis. Recuperation will be accelerated by compensatory supplementation of trace elements. Therefore, selective medication with adequate trace element compounds in patients with thoracic empyema can be generally recommended for zinc. The other elements need not necessarily be monitored or substituted, because of their stable concentrations in the serum. Rb may have a biological impact, but deficiency symptoms in man are not clearly defined.

Hyperoxia-induced changes in antioxidant capacity and the effect of dietary antioxidants.

We investigated, by measuring oxygen radical absorbance capacity (ORAC), whether hyperoxia causes alterations in antioxidant status and whether these alterations could be modulated by dietary antioxidants. Rats were fed for 8 wk a control diet or a control diet supplemented with vitamin E (500 IU/kg) or with aqueous extracts (ORAC: 1.36 mmol Trolox equivalents/kg) from blueberries or spinach and then were exposed to air or >99% O2 for 48 h. Although the constituents of the extracts were not extensively characterized, HPLC indicated that blueberry extract was particularly rich in anthocyanins, and the spinach extract did not contain any anthocyanins. The ORAC was determined in samples without proteins [serum treated with perchloric acid (PCA); ORACPCA] and with proteins (ORACtot). Hyperoxia induced a decrease in serum protein concentration, an increase in serum ORACPCA, decreases in lung ORACPCA and ORACtot, and an equilibration of proteins and ORACPCA between serum and pleural effusion. These alterations suggested a redistribution of antioxidants between tissues and an increase in capillary permeability during hyperoxia. Only the blueberry extract was effective in alleviating the hyperoxia-induced redistribution of antioxidants between tissues.

Serum and pleural fluid selenium, copper, zinc, and magnesium levels in malignant and nonmalignant pleural diseases.

In the present study, selenium (Se), copper (Cu), zinc (Zn), and magnesium (Mg) levels in serum and pleural fluid from patients with malignant and nonmalignant pleural diseases were measured and compared with serum concentrations in healthy subjects. Serum/pleural fluid ratios were also calculated for each element. The purpose of this study was to evaluate the diagnostic value of trace metals, especially Se, in neoplastic and nonneoplastic pleural diseases. Serum Cu and Mg levels were significantly higher in both malignant and nonmalignant groups of patients when compared with control subjects (p < 0.05). However, serum levels of these elements did not show a significant difference between malignant and nonmalignant cases (p > 0.05). The serum/pleural fluid ratio of Zn was significantly lower in patients with malignant effusions than in benign conditions (p = 0.05). Serum and pleural fluid Se, Cu, Zn and Mg levels were not significantly different between the two groups (p > 0.05). Thus, Se, Cu, Zn, and Mg seem to have no diagnostic value for distinguishing malignant from nonmalignant effusions.

Activation of plasma kallikrein-kinin system and its significant role in pleural fluid accumulation of rat carrageenin-induced pleurisy.

Rat pleurisy was induced by intrapleural injection of lambda-carrageenin. The pleural exudate began to be accumulated 1-3 h after carrageenin administration and showed a peak at 19 h. The levels of prekallikrein and high-molecular-weight (HMW), but not low-molecular-weight (LMW), kininogen in the pleural fluid were markedly decreased when compared with those in plasma. Prekallikrein in rat plasma was activated by incubation with carrageenin in vitro. Captopril increased the plasma exudation significantly at 1-5 h. Depletion of prekallikrein and HMW kininogen in rat plasma by preadministration of bromelain caused marked inhibition of the plasma exudation at 1-24 h. The rest of the plasma exudation after bromelain was further decreased by simultaneous pretreatment of rats with both bromelain and aspirin. These results clearly indicate that plasma prekallikrein was activated in the pleural cavity and bradykinin released was responsible for plasma exudation during the entire course of this pleurisy.