Thymic MALT lymphoma associated with Sjögren's syndrome with postoperative cardiac tamponade and acute pleuritis: a case report.

BACKGROUND: Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS. CASE PRESENTATION: A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis. CONCLUSIONS: Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.

Anatomy and pathology of lymphatic vessels under physiological and inflammatory conditions in the mouse diaphragm.

The lymphatic vessels in the parietal pleura drain fluids. Impaired drainage function and excessive fluid entry in the pleural cavity accumulate effusion. The rat diaphragmatic lymphatics drain fluids from the pleura to the muscle layer. Lymphatic subtypes are characterized by the major distribution of discontinuous button-like endothelial junctions (buttons) in initial lymphatics and continuous zipper-like junctions (zippers) in the collecting lymphatics. Inflammation replaced buttons with zippers in tracheal lymphatics. In the mouse diaphragm, the structural relationship between the lymphatics and blood vessels, the presence of lymphatics in the muscle layer, and the distributions of initial and collecting lymphatics are unclear. Moreover, the endothelial junctional alterations and effects of vascular endothelial growth factor receptor (VEGFR) inhibition under pleural inflammation are unclear. We subjected the whole-mount mouse diaphragms to immunohistochemistry. The lymphatics and blood vessels were distributed in different layers of the pleural membrane. Major lymphatic subtypes were initial lymphatics in the pleura and collecting lymphatics in the muscle layer. Chronic pleural inflammation disorganized the stratified layers of the lymphatics and blood vessels and replaced buttons with zippers in the pleural lymphatics, which impaired drainage function. VEGFR inhibition under inflammation maintained the vascular structures and drainage function. In addition, VEGFR inhibition maintained the lymphatic endothelial junctions and reduced the blood vessel permeability under inflammation. These findings may provide new targets for managing pleural effusions caused by inflammation, such as pleuritis and empyema, which are common pneumonia comorbidities.

Anatomy and function of the lymphatic vessels in the parietal pleura and their plasticity under inflammation in mice.

Inflammatory pleuritis often causes pleural effusions, which are drained through lymphatic vessels (lymphatics) in the parietal pleura. The distribution of button- and zipper-like endothelial junctions can identify the subtypes of lymphatics, the initial, pre-collecting, and collecting lymphatics. Vascular endothelial growth factor receptor (VEGFR)-3 and its ligands VEGF-C/D are crucial lymphangiogenic factors. Currently, in the pleura covering the chest walls, the anatomy of the lymphatics and connecting networks of blood vessels are incompletely understood. Moreover, their pathological and functional plasticity under inflammation and the effects of VEGFR inhibition are unclear. This study aimed to learn the above-unanswered questions and immunostained mouse chest walls as whole-mount specimens. Confocal microscopic images and their 3-dimensional reconstruction analyzed the vasculatures. Repeated intra-pleural cavity lipopolysaccharide challenge induced pleuritis, which was also treated with VEGFR inhibition. Levels of vascular-related factors were evaluated by quantitative real-time polymerase chain reaction. We observed the initial lymphatics in the intercostals, collecting lymphatics under the ribs, and pre-collecting lymphatics connecting both. Arteries branched into capillaries and gathered into veins from the cranial to the caudal side. Lymphatics and blood vessels were in different layers with an adjacent distribution of the lymphatic layer to the pleural cavity. Inflammatory pleuritis elevated expression levels of VEGF-C/D and angiopoietin-2, induced lymphangiogenesis and blood vessel remodeling, and disorganized the lymphatic structures and subtypes. The disorganized lymphatics showed large sheet-like structures with many branches and holes inside. Such lymphatics were abundant in zipper-like endothelial junctions with some button-like junctions. The blood vessels were tortuous and had various diameters and complex networks. Stratified layers of lymphatics and blood vessels were disorganized, with impaired drainage function. VEGFR inhibition partially maintained their structures and drainage function. These findings demonstrate anatomy and pathological changes of the vasculatures in the parietal pleura and their potential as a novel therapeutic target.

An unusual case of checkpoint-inhibitor-induced pleuropericarditis.

INTRODUCTION: Pembrolizumab is an immune checkpoint inhibitor that promotes effector T-cell functions on malignant cells by binding to programmed cell death protein 1 (PD-1). Pembrolizumab is well tolerated in most cases with an adverse event profile consisting mainly of pruritus, fatigue, and anorexia. Cardiotoxicity comprises 1% of the total adverse events. CASE REPORT: We present a case of a 64-year-old female with non-small cell lung cancer (NSCLC) who developed pleuropericarditis following pembrolizumab therapy. MANAGEMENT & OUTCOME: The patient was successfully managed with colchicine, furosemide, and timely initiation of methylprednisolone with the improvement of her symptoms. The decision to discontinue pembrolizumab was made, and six months after this intervention, the patient has remained asymptomatic. DISCUSSION: Clinicians should recognize these potential immune-mediated adverse effects to provide effective and timely management and optimize patient care.

Diagnostic imaging and histopathologic features of rounded atelectasis in four cats and one dog: A descriptive case series study.

In humans, rounded atelectasis is defined as focal lung collapse that radiologically appears as a round mass-like lesion in the periphery of the lung. In general, human patients with rounded atelectasis have a history of pleural effusion and abnormal pleura and characteristic CT findings help to distinguish rounded atelectasis from pulmonary neoplasia without the need for invasive surgical biopsy. This retrospective multi-center case series describes rounded atelectasis in four cats and one dog. Chylothorax was seen in four patients and an eosinophilic and lymphoplasmacytic effusion was seen in one patient. All patients had solitary or multifocal subpleural pulmonary masses (26 masses total in 5 patients) with diffuse, multifocal, or focal visceral and parietal pleural thickening. All the masses but one were broad-based towards the visceral pleura. Masses were most common in the ventral or lateral aspect of the lungs. Indistinctness at the hilar aspect of the lesion was seen in all masses; a "comet tail" sign was seen in 14 of 26 masses. On postcontrast images, the lesions were homogeneously enhanced in 24 of 26 masses and heterogeneous in two of 26 masses. Other findings include ground glass opacities (n = 5), parenchymal bands (n = 4), mild to moderate lymphadenopathy (n = 4), and compensatory hyperinflation of the lung lobes not affected by atelectasis (n = 2). Histopathology of four cases revealed atelectasis with fixed pleural folds, chronic pleuritis, and mild to moderate pleural fibrosis. Awareness of rounded atelectasis in veterinary species will enable inclusion of a benign etiology into the differential diagnosis for subpleural masses in cases with pleural abnormalities.

CT features of rounded atelectasis in chronic inflammatory pleural effusions in cats and dogs.

Rounded atelectasis is well described in human medicine as focal lung deformation and collapse secondary to inflammatory pleural effusions and pleuritis. Specific CT features (round to ovoid soft tissue pulmonary attenuations, creation of an acute angle with the adjoining visceral pleura, and the presence of perinodular comet tail signs) support the diagnosis of rounded atelectasis in humans so that further diagnostic workup is not necessary in defining the nodules. In this retrospective case series, we described the CT characteristics of rounded atelectasis in eight cats and three dogs diagnosed with restrictive pleuritis secondary to either a chylothorax or pyothorax. Thirty-six soft tissue attenuating pulmonary nodular lesions were identified on CT. Comet tail signs, consisting of bundles of bronchi and vessels coalescing into the pulmonary nodules, were associated with 92% of the nodules (33/36), and 92% of the nodules abutted and created an acute angle with the pleura (33/36). Other prevalent features included location in gravity-dependent regions of the lung lobes (33/36, 92%), blurred hilar margins with sharper pleural margins of the nodules (33/36, 92%), presence of air bronchograms (30/36, 83%), homogeneous contrast-enhancement (23/36, 64%), and volume loss of the affected lung lobe (22/36, 61%). Pulmonary malignant neoplasms were not found cytologically (6/11 patients) or histologically (5/11 patients). To avoid a misdiagnosis of neoplasia, veterinary radiologists should be aware of the CT features of rounded atelectasis and consider it as a differential for pulmonary nodular lesions in patients with concurrent inflammatory pleural effusion and pleuritis.

Exploring the pathophysiologic basis of constrictive pericarditis of Kohlmeier Degos disease: A case series and review of the literature.

Kohlmeier-Degos Disease is a unique thrombotic microvascular and arteriopathic vasculopathy that is highly selective in the organs it targets. It invariably involves the skin and can be a purely cutaneous process. It affects both the microvasculature and the arterial system ranging from a thrombogenic microangiopathy to a fibrointimal obliterative arteriopathy with an accompanying background of extravascular fibrosis. A potentially lethal complication of Kohlmeier-Degos disease is constrictive pericarditis and pleuritis. We present three male patients, ages 26 years, 46 years and 58 years of age with established cutaneous and gastrointestinal Kohlmeier-Degos disease who developed progressive pericarditis which in two necessitated a pericardiectomy. There are 6 other reported cases, 5 in men, with restrictive symptoms developing on average 6 years following the onset of skin disease and all with gastrointestinal involvement. Half of the patients died within one year following the diagnosis of cardiopulmonary restrictive disease. The restrictive symptoms developed within 12 months, 2 years and 11 years following the initial skin presentation. In one patient this complication developed despite receiving eculizumab, indicative that this extravascular fibrosing reaction was not complement mediated as opposed to the thrombotic microvascular component of the disease which is C5b-9 mediated. Two of the three patients had evidence of right ventricular dysfunction. Two of our patients died within 1 year of developing constrictive pericarditis due to progressive cardiopulmonary failure. A profibrogenic process resembling scleroderma was seen given the degree of smooth muscle actin staining along with a mirror image reduction in CD34 expression within the fibrotic pleura and pericardium. There was significant upregulation in type I interferon signaling in cases tested as revealed by the degree of staining for MXA, the surrogate type I interferon marker. We propose that excessive type I interferon signaling results in the influx of monocyte derived dendritic cells with subsequent transdifferentiation into potent collagen producing myofibroblasts. We believe that targeting and suppressing type I interferon signaling should be a cornerstone of early therapy in patients with Kohlmeier- Degos disease to prevent pleural and pericardial fibrosis.

Chest pain from pneumologist point of view.

Chest pain is one of the most common symptoms encountered by doctors working in acute, internal, and pulmonary clinics. In the United States in 2006, 10 percent of all visits to the emergency room were caused by diseases of the respiratory system, and chest pain was the most common symptom. The most common situations that can cause chest pain with an emphasis on their diagnosis and early treatment are chest infections, pneumothorax, pneumomediastinum and tumors affecting the pleural cavity.

Host biomarkers for monitoring therapeutic response in extrapulmonary tuberculosis.

PURPOSE: The aim of this study was to explore the utility of inflammatory biomarkers in the peripheral blood to predict response to treatment in extrapulmonary tuberculosis (EPTB). METHODS: A Luminex xMAP-based multiplex immunoassay was used to measure 40 inflammatory biomarkers in un-stimulated plasma of 91 EPTB patients (48 lymphadenitis, and 43 pleuritis) before and at 2 and 6 months of treatment. RESULTS: Overall a significant change was observed in 28 inflammatory biomarkers with treatment in EPTB patients. However, MIG/CXCL9, IP-10/CXCL10, and CCL23 decreased in all patients' groups with successful treatment at both time points. At 2 months, 29/64 (45%) patients responded partially while 35/64 (55%) showed complete regress. Among good responders, a higher number of biomarkers (16/40) reduced significantly as compared to partial responders (1/40). Almost half (14/29) of partial responders required longer treatment than 6 months to achieve satisfactory response. The levels of MIG, IP-10, MIF, CCL22 and CCL23 reduced significantly among 80, 74, 60, 71, 51% good responders, as compared to 52, 52, 52, 59, 52% partial responders, respectively. A biosignature, defined by a significant decrease in any one of these five biomarkers, corresponded with satisfactory response to treatment in 97% patients at 2 month and 99% patients at 6 months of treatment. CONCLUSION: Change in inflammatory biomarkers correlates with treatment success. A five biomarker biosignature (MIG, IP-10, MIF, CCL22 and CCL23) could be used as an indicator of treatment success.

Prevalence and risk factors for serositis in patients with systemic lupus erythematosus: A case-control study.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. METHODS: A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. RESULTS: The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% (p = 0.001, 95% CI: 1.7-42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method (p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid (p = 0.021) and, marginally, more belimumab (p = 0.056). CONCLUSION: The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.

Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature.

BACKGROUND: Chlamydia pneumoniae is a common cause of atypical community acquired pneumonia (CAP). The diagnostic approach of chlamydial infections remains a challenge. Diagnosis of delayed chlamydial-associated complications, involving complex autoimmune pathophysiological mechanisms, is still more challenging. C. pneumoniae-related cardiac complications have been rarely reported, including cases of endocarditis, myocarditis and pericarditis. CASE PRESENTATION: A 40-year old female was hospitalized for pleuropericarditis following lower respiratory tract infection. The patient had been hospitalized for CAP (fever, dyspnea, chest X-ray positive for consolidation on the left upper lobe) 5 weeks ago and had received ceftriaxone and moxifloxacin. Four weeks after her discharge, the patient presented with fever, shortness of breath and pleuritic chest pain and was readmitted because of pericardial and bilateral pleural effusions (mainly left). The patient did not improve on antibiotics and sequential introduction of colchicine and methylprednisolone was performed. The patient presented impressive clinical and laboratory response. Several laboratory and clinical assessments failed to demonstrate any etiological factor for serositis. Chlamydial IgM and IgG antibodies were positive and serial measurements showed increasing kinetics for IgG. Gold standard polymerase chain reaction of respiratory tract samples was not feasible but possibly would not have provided any additional information since CAP occurred 5 weeks ago. The patient was discharged under colchicine and tapered methylprednisolone course. During regular clinic visits, she remained in good clinical condition without pericardial and pleural effusions relapse. CONCLUSIONS: C. pneumoniae should be considered as possible pathogen in case of pleuritis and/or pericarditis during or after a lower respiratory tract infection. In a systematic review of the literature only five cases of C. pneumoniae associated pericarditis were identified. Exact mechanisms of cardiovascular damage have not yet been defined, yet autoimmune pathways might be implicated.

An Elderly Male with Primary Sjögren's Syndrome Presenting Pleuritis as the Initial Manifestation.

Primary Sjögren's syndrome (SS) is an autoimmune disease that usually affects the exocrine glands in mid-dle-aged women. Fifteen percent of SS patients experience severe systemic extraglandular complications, and pleuritis is one of the rare complications of SS. We report the case of an elderly Japanese man who initially pre-sented with a prolonged fever and chest pain and was finally diagnosed with primary SS-associated pleuritis. Of the nine reported cases of primary SS that initially presented with pleuritis, up to six cases were elderly males. This case highlights the complication of pleuritis among elderly males with primary SS.

[Intraoperative pleurodesis with talc and trichloroacetic acid for exudative pleuritis]. / Intraoperatsionnyi plevrodez tal'kom i trikhloruksusnoi kislotoi pri ekssudativnykh plevritakh.

OBJECTIVE: To compare the efficacy of chemical pleurodesis with talc and trichloroacetic acid during thoracoscopy. MATERIAL AND METHODS: Thoracoscopy with pleural biopsy was performed in 355 (83.5%) out of 424 patients with pleural effusion. Pleurodesis was ensured by intraoperative insufflation of talc powder (n=135) and application of 33% trichloroacetic acid solution to parietal and visceral pleura (n=19) in patients with malignant (125), inflammatory (6), post-traumatic (4), tuberculous (3), pancreatogenic (8) and hepatogenic (8) effusions. Drainage tubes were removed if daily drainage output volume was less than 100 ml or complete lung inflation was observed. RESULTS: Post-pleurodesis drainage took 7.1±5.4 days. Two patients developed bumpy rashes that were initially interpreted as carcinomatosis. However, these rashes were later identified as tuberculosis. Retrospectively, these patients were not good candidates for pleurodesis. Pleurodesis with talc suppressed exudation in 89.6% of cases. Complications developed in 4 cases (3%): pneumonia (1) and pleural empyema (3). These complications were associated with a violation of technical procedure of pleurodesis, i.e. procedure in rigid lung, atelectasis (1) and bronchopleural fistula (2). Mean duration of drainage after trichloroacetic acid-induced pleurodesis was 7.9±6.7 days. This procedure was effective in 84.2% of cases, and there were no complications. There are no previous reports on the use of this pleurodesis technique in the literature. Mean duration of drainage after talc-induced pleurodesis was decreased up to 6.9±5.4 days in patients with malignant pleural effusion (p<0.05), after trichloroacetic acid-induced pleurodesis - up to 7.5±8.1 days (p>0.05) compared to patients without pleurodesis (9.1±11.2 days). CONCLUSION: Pleurodesis with talc or trichloroacetic acid during thoracoscopy is effective for pleural effusions following malignancies, liver, kidney and cardiac diseases with decompensation. Essential requirements are adequate lung inflation, no atelectasis and bronchopleural fistula.

[Causes of resistant pleural effusions and efficiency of chemical pleurodesis in these patients]. / Prichiny rezistentnykh plevral'nykh vypotov i effektivnost' khimicheskogo plevrodeza v ikh lechenii.

OBJECTIVE: To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients. MATERIAL AND METHODS: Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage. RESULTS: In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube. CONCLUSION: Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.

Non-necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia.

AIMS: Reports of respiratory illnesses among soldiers returning from Southwest Asia have been described. During deployment to Southwest Asia, soldiers are exposed to various respiratory hazards, including dust storms, smoke from burn pits and industrial air pollutants. A few studies have reported increased rates of constrictive bronchiolitis and asthma in these patients. We sought to expand upon the pathological findings in this cohort. METHODS AND RESULTS: Lung biopsies from veterans of Southwest Asia were identified and re-reviewed. All patients had undergone pulmonary function tests and chest high-resolution CT imaging with no significant findings. Overall, 59 patients with a history of inhalational exposure to at least one of the following were identified: smoke from burn pit, dust storm and sulphur plant fire. Samples included video-assisted thoracoscopic lung biopsies (57 of 59, 96.6%) and cryobiopsies (two of 59, 3.4%). Patients were predominantly male (54 of 59, 91.5%) with an age range of 24-55 years (mean and median = 35). Non-necrotising, poorly formed granulomas were identified in 22 cases (22 of 59, 37.2%). The granulomas were mainly bronchiolocentric and were associated with chronic lymphoplasmacytic bronchiolitis, similar to hypersensitivity pneumonitis (HP). Pleural reaction in the form of focal chronic lymphocytic pleuritis and/or focal pleural adhesions were seen in 43 of 57 (75.4%) biopsies. CONCLUSIONS: To our knowledge, this is the first study to report pleural reaction as well as features of HP in this population, suggesting that pleural reaction and HP may be part of the spectrum of Southwest Asia deployment-related lung diseases.

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.

Current strategy for treatment of comorbid states: complicated community-acquired pneumonia with arterial hypertension.

OBJECTIVE: The aim: To optimize the treatment of CAP patients with hypertension, complicated by exudative pleuritis. PATIENTS AND METHODS: Materials and methods: The study included 43 CAP patients, aged 46 to 65 years, with viral lesions along with hypertension. The average age of the patients was 52.5 ± 4.5 years. Verification of the CAP diagnosis and its formulation was performed in accordance with the order of the Ministry of Health of Ukraine No. 128 of 19.03.2007 "On the approval of clinical protocols of medical care in "Pulmonology" in all patients, pneumonia was complicated by exudative pleuritis, which was confirmed by X-ray examination. RESULTS: Results: The use of combination drugs, namely, torasemide with prolonged effect and tivortin aspartate in the treatment of patients with community-acquired pneumonia, complicated by exudative pleuritis, combined with hypertension led to more significant positive changes in the values of saturation, blood biochemical parameters, as well as accelerated recovery of patients, which was confirmed by the positive dynamics of X-ray examination. CONCLUSION: Conclusions: As a result of the treatment, all parameters of the quality of life of the patients were greatly improved, which resulted in a significant reduction in functional limitations and high social activity of the patients, which significantly reduced the cost of treatment.

[Analysis of endothelial dysfunction in the context of pleural effusions of various origins using skin thermometry]. / Issledovanie endotelial'noi disfunktsii pri plevral'nykh vypotakh razlichnoi etiologii metodom teplovoi kozhnoi termometrii.

OBJECTIVE: To analyze the mechanisms and severity of endothelial dysfunction in patients with pleural effusion of various origins using skin thermometry. MATERIAL AND METHODS: We studied microcirculation in 135 patients with pleural effusions of various origins. Local skin thermometry and computer wavelet analysis were performed in 3-5 days after thoracoscopy with pleural biopsy using Microtest-100WF device with a temperature measuring resolution of 0.001°C. We estimated endothelial, myogenic and neurogenic indices using spectral analysis of skin temperature fluctuations in a range 0.0095-2 Hz. The control group comprised 40 healthy participants aged 23-36 years. RESULTS: Three groups of patients were distinguished depending on the cause of effusion: malignant pleural effusions (n=65, 48.1%); inflammatory pleural effusions (para-pneumonic, post-traumatic, pancreatogenic, tuberculous) (n=58, 43%); transudates (hepatogenic, cardiogenic, and nephrogenic) (n=12, 8.9%). There were no significant differences in vascular tone in response to local heating of the second finger of the hand up to 40°C. Measurements were carried out within 10 min in all groups. Patients with diabetes mellitus and cardiovascular diseases (n=48, 35.6%) had significant decrease of thermal vasodilation index in endothelial range up to 2.93±1.77, in the control group - up to 4.21±2.40 (p=0.041). CONCLUSION: Endothelial dysfunction is a universal non-specific aspect in pathogenesis of various diseases. This process is essential in pleural effusion. Local thermometry and computer wavelet analysis revealed no significant differences between patients with malignant, inflammatory and transudative pleural effusions. Pleural effusions in the context of cardiovascular pathology and/or diabetes mellitus occur due to impaired vasodilatation mechanisms in endothelial range.

[Diagnosis of malignant pleural effusions using convolutional neural networks by the morphometric image analysis of facies of pleural exudate]. / Diagnostika zlokachestvennykh plevral'nykh vypotov s pomoshch'yu svertochnykh neironnykh setei putem morfometricheskogo analiza izobrazhenii fatsii plevral'nogo ekssudata.

OBJECTIVE: To estimate the possibility of diagnosis of malignant pleural effusion using convolutional neural networks of facies images of pleural exudates obtained by the method of wedge-shaped dehydration. MATERIAL AND METHODS: We studied 163 images of pleural fluid facies obtained by wedge-shaped dehydration in patients with various pleural effusions (10 nosological groups). Recognition and analysis were carried out using convolutional neural network. The images were divided into two groups - malignant effusion (n=65; 40%) and other diseases (n=98; 60%). RESULTS: There were 131 photos selected for further investigation after pre-processing of images by eliminating defective ones, turning them into black and white format, cleaning of 'noise', cutting out the facies. Then the images were standardized. The method of rigid transformations with rotation for every 10 degrees was used. As a result, their number increased up to 4,585. Self-taught neural network analyzed the images of facies independently by separation of the fragments consisting of black and white dots and comparison of them with each other. Self-teaching and training of each neural network were ensured by random sampling of 80% of images from the initial sample. Then the remaining 20% of the images were used as a control sample to assess the possibilities of recognition pleural effusion cause. Four options of convolutional neural networks were used. An accuracy of cancer detection ranged from 82% to 95.6%, benign diseases - from 84% to 94.7%. The neural network with the highest sensitivity was chosen. CONCLUSION: Automated image analysis system of pleural effusion facies using convolutional neural network ensured an accuracy of diagnosis of malignant pleural effusion in 95,6% of cases and other diseases in 90% of cases. The method is simple, efficient, cheap and reagentless.

The bacteriology in adult patients with pneumonia and parapneumonic effusions: increased yield with DNA sequencing method.

The aim of this study was to use a 16S rDNA sequencing method in combination with conventional culture in patients with parapneumonic effusions (PPE) to evaluate the methods, study the microbiological spectrum, and examine the presence of bacteria within the different stages of PPE. Adults with community-acquired pneumonia (CAP) and PPE (n = 197) admitted to the Departments of Infectious Diseases at four hospitals in Stockholm County during 2011-2014 were prospectively studied. All patients underwent thoracentesis. Twenty-seven non-infectious pleural effusions were used as controls. The pleural samples were analyzed with culture, 16S rDNA sequencing, pH, glucose, and lactate dehydrogenase. Microbiological etiology was found in 99/197 (50%) of the patients with mixed infections in 20 cases. The most common pathogens were viridans streptococci (n = 37) and anaerobic bacteria (n = 40). Among the 152 patients with both methods performed, 26/152 (17%) and 94/152 (62%) had bacteria identified with culture and 16S rDNA sequencing respectively (p < 0.001). In 24/26 (92%) culture-positive cases, the same organism was identified by 16S rDNA. All controls were negative in both methods. Among the patients with complicated PPE and complete sampling, bacteria were found in 69/74 patients (93%), all detected with 16S rDNA sequencing, compared to 23/74 (31%) culture-positive samples (p < 0.001). Compared with culture, 16S rDNA sequencing substantially improved the microbiological yield, a microbiological diagnosis was achieved in almost all patients with complicated PPE, and the specificity seemed to be high. 16S rDNA sequencing should be used together with culture in patients with PPE to guide antibiotic therapy.