Alteration in the levels of pyrazinamide in pleural fluid following simultaneous administration of prednisoline in patients of tubercular pleural effusion.

20 Patients of tuberculous pleural effusion were administered a combination of pyrazinamide (30 mg/kg) + isoniazid (300 mg) orally for 7 consecutive days and pyrazinamide was estimated by spectrophotometric method in serum and pleural fluid. Prednisolone was added to the above regimen for next 7 consecutive days and pyrazinamide was again estimated. The level of pyrazinamide in pleural fluid was 23.4 +/- 1.2 (micrograms/ml). Following addition of prednisolone the level increased (27.6 +/- 1.3) significantly (P less than 0.001). The serum pyrazinamide level was not influenced by simultaneous administration of prednisolone. The pleural fluid/serum pyrazinamide ratio was increased from 0.465 to 0.542 by the addition of prednisolone to therapeutic regimen.

Lavado pleural en hemotórax reciente: estudio experimental / Pleural lavage in fresh hemothorax: experimental study

Con el objeto de determinar si el lavado pleural precoz, en un hemotórax estabilizado, es capaz de mejorar el aseo pleural, se realizó un estudio experimental en perros a los que se les provocó un hemotórax izquierdo de 300 cc, se les dejó reposar 1 hora y luego se les instaló un tubo tygon » multiperforado por la línea media axilar, 6- espacio intercostal. En 5 perros (grupo A), el tubo se conectó a una trampa de agua y se mantuvo durante 6 horas. En los 5 perros restantes (grupo B), se aspiró con jeringa de 50 cc la sangre que fluyó fácil, y luego se realizó lavados con suero fisiológico. Contemplando el tratamiento se retiró el tubo, se suturó la herida y el perro se dejó en observación por 24 horas, después de las cuales se sacrificó y se midió la cantidad de sangre retenida, pesando los coágulos. Se tomó biopsia de la pleura parietal, sobre la curva posterior de la 7ª costilla y de pleura visceral, en el borde inferior del lóbulo inferior del pulmón. Se realizó análisis de variancia y t test. La duración promedio del tratamiento fue: a) 6 horas; b) 45 minutos: el volumen promedio de sangre extraído con el tratamiento; a) 127 cc; b) 208 cc (p<0,01). El volumen promedio de sangre retenida: a) 51,9 gr; b) 10,8 gr (p=0,0001). Biopsia: a) inflamación y depósito hemático sobre las pleuras; b) inflamación. Se concluye que el lavado pleural con suero fisiolólogico, produce una mejor evacuación del hemotórax

The pathogenesis of low pleural fluid glucose in acidotic malignant pleural effusions.

To clarify the pathogenesis of low glucose concentrations in acidotic pleural fluid of malignant effusion, simultaneous studies of 1) serial plasma-pleural fluid glucose, pH, PCO2, gentamicin, tobramycin and netilmicin in vivo, and 2) serial in vitro incubation of pleural fluid pH and PCO2 were conducted in 19 cases. In all effusion samples, the pleural fluid pH and PO2 levels were lower and the CO2 levels were higher than those of arterial blood, respectively. The pleural fluid aminoglycoside levels increased gradually, reaching the maximum values after about four to seven hours, thereafter, it gradually decreased. There were three types of serial pleural fluid-plasma glucose concentrations, of which types 2 and 3 showed either a delayed rise or no rise in pleural fluid glucose concentrations, respectively. Serial pleural fluid pH and PCO2 levels remained stable during the in vitro incubation study, especially during the first three hours. The pleural fluid kinetics of the three aminoglycosides followed a large reservoir model without any relationships to pleural fluid pH, PCO2, fluid-volume and no significant differences of the kinetics among the three aminoglycosides. This indicated that the diffusion block of the antibiotics did not depend on molecular weight nor pH, PCO2 dependent. Since the molecular weight of three aminoglycosides is greater than that of glucose, lactic acid, CO2 and O2, it may be concluded, therefore, that an over utilization of glucose and O2 with an over production of lactic acid and CO2 by the pleura, rather than glucose transport defect, results in a low glucose concentration in malignant effusions.