Bacterial Pneumonia with Chest Pain Successfully Treated with Saikanto in a Patient with an Antimicrobial Allergy / 日本東洋医学雑誌

A 64 year-old female presented with fever and cough. She had suffered from a cough for one day and we treated her with saikokeishito. However, her symptoms got worse and she developed chest pain. She was diagnosed with bacterial pneumonia at another clinic and she was referred to our hospital 3 days after starting saikokeishito. Her X-ray showed right infiltration in her lung and her blood examination had signs of inflammation. Pneumonia with pleuritis was suspected, but she was allergic to antibacterial drugs and hoped to continue Kampo treatment. We switched saikokeishito to saikanto. Her chest pain decreased soon after taking saikanto and 4 days later only a slight cough remained. Eleven days later, her inflammatory reaction improved. Kampo formulas containing Bupleuri radix are usually selected for pneumonia or pleuritis according to a patient' s pattern identification. We gave her saikanto, a mixture of shosaikoto and shokankyoto, because she had chest pain. Saikanto was significantly effective. There have been few clinical reports about treatment for pneumonia with Kampo medicine alone without using antibacterial drugs. We believe this case shows that Kampo treatment is effective for pneumonia and pleuritis.

A Case of Pleural Effusion Due to Bacterial Pleurisy Markedly Reduced by Treatment with Saikanto / 日本東洋医学雑誌

Although saikanto has often been used for infectious pleuritis, there are few reports on the usefulness of it in recent years. We experienced a patient successfully treated with saikanto, who was suffering from bacterial pleuritis with residual pleural effusion, which was difficult to drain and treat with antibacterial drugs. Kampo treatment including saikanto should be used for pleuritis that is not sufficiently improved by Western medical treatment alone.

Values of IL-27 and IFN-γ in pleural effusion in diagnosis of tuberculous pleuritis / 吉林大学学报(医学版)

Objective: To detect the levels of interleukin-27 (IL-27) and interferon-γ (IFN-γ) in pleural effusion, and to explore the values of IL-27 and IFN-y in the diagnosis of tuberculous pleuritis. Methods: A total of 88 patients with pleural effusion were selected and divided into tuberculous pleural effusion (TPE) group (n = 4 4), malignant pleural effusion group (n = 2 0), parapneumonia pleural effusion group (n = 12), and transudative pleural effusion group (n = 1 2) . The levels of IL-27, IFN-y and adenosine deaminase (ADA) in pleural effusion of the patients in various groups were detected; the receiver operating characteristic (ROC) curve was drawn to evaluate their diagnostic values for tuberculous pleuritis. Results: The levels of IL-27 and IFN-γ in pleural effusion of the patients in TPE group were significantly higher than the other three groups (P < 0 . 05). The areas under ROC curve (AUC) of IL-27, IFN-γ and ADA in pleural effusion in diagnosis of tuberculous pleuritis were 0. 96, 0. 79 and 0. 92, respectively; the specificities were 94. 4%, 89. 5% and 92. 1%, respectively; the sensitivities were 100%, 61. 4% and 78. 6%, respectively. The specificity (97. 4%) of combined detection of IL-27, IFN-γ and ADA was higher than those of single detection. Conclusion: The levels of IL-27, IFN-γ and ADA in pleural effusion can be used as an effective method to the differential diagnosis of tuberculous pleuritis. Detection of IL-27 in pleural effusion has a higher diagnostic value for tuberculous pleuritis than IFN-γ and ADA. Combined detection of IL-27, IFN-y and ADA has the important value in the diagnosis of tuberculous pleuritis.

Risk factors predicting development of complications in 72 dogs with esophageal foreign bodies / 대한수의학회지

The aim of this study was to determine predictive risk factors implicated in complications in dogs with esophageal foreign bodies. Medical records of 72 dogs diagnosed with esophageal foreign bodies by endoscopy were reviewed retrospectively. Factors analyzed included age; breed; gender; body weight, location, dimension, and type of foreign body; and duration of impaction. To identify risk factors associated with complications after foreign body ingestion, categorical variables were analyzed using the chi-square or Fisher's exact tests and multivariate analysis, as appropriate. Complications secondary to esophageal foreign body ingestion included megaesophagus, esophagitis, perforation, laceration, diverticulum, and pleuritis. Univariate analysis revealed that the location and duration of impaction after foreign body ingestion were associated with an increased risk of esophageal laceration and perforation. Multivariate analysis showed that age, duration of impaction, and foreign body dimension were significant independent risk factors associated with the development of complications in dogs with esophageal foreign bodies. In conclusion, these results showed that longer duration of impaction and larger foreign body dimensions may increase the risks of esophageal laceration, perforation, and plueritis in dogs.

Efficacy of a new therapeutic approach as initial treatment for tuberculous pleuritis / 中国感染控制杂志

Objective To explore the therapeutic efficacy of levofloxacin combined with anti-tuberculosis drugs and thoracic catheterization for the treatment of tuberculous pleuritis.Methods Patients who were admitted to Departments of Infectious Diseases of Hanzhong Central Hospital and Ankang Central Hospital between February 2014 and August 2016 for initial treatment of tuberculous pleuritis were included in the study,they were divided into groups A,B,C and D.Group A received 2HRZE + 7HR regimen combined with conventional drainage;group B received 2HRZE+ 7HR regimen combined with thoracic catheterization;group C received 2HRZEV + 7HR regimen combined with thoracic catheterization;group D received 2HRZEV + 10HR regimen combined with thoracic catheterization.groups B,C and D received thoracic catheterization,normal saline 20mL and urokinase 100,000U were given through the drainage tube.Results A total of 172 patients with newly diagnosed tuberctlous pleurisy were received for treatment.There were 45,53,38,and 36 cases in group A,B,C,and D respectively.The total effective rate of therapy for pleural effusion in group A was lower than that in group B(64.44％ vs 90.57％,x2 =9.863,P＜ 0.05);after two month therapy,total effective rate of therapy for pleural effusion in group B was lower than that in group C (18.87％ vs 39.47％,x2 =4.716,P＜0.05);at the end of therapy,total effective rate in group C was lower than that in group D (60.53 ％ vs 83.33 ％,x2 =4.731,P＜0.05).Conclusion For initial treatment of patients with tuberculous pleuritis,2HRZEV + 10HR antituberculosis regimen combined with thoracic catheterization and urokinase infusion can significantly improve the clinical symptoms and recovery rate of tuberculous pleuritis,facilitate drainage of pleural effusion and prevent pleural thickening,adhesion and encapsulation.

Clinical significance of adenosine deaminase in tuberculosis pleuritis in children / 国际儿科学杂志

Objective To explore the clinical significance of adenosine deaminase ( ADA) in pleural ef-fusion for diagnosis of tuberculosis pleuritis in children. Methods The level of ADA in pleural effusion was ret-rospectively analyzed in 28 cases with purulent pleuritis,thirty-four cases with mycoplasma pneumoniae pleuri-tis,forty-five cases with tuberculosis pleuritis from July 2011 to January 2014 in Beijing Children′s Hospital Af-filiated to Capital Medical University. Results The level of ADA in three groups was expressed by median (range interquartile). ADA in the purulent pleuritis group [126. 35 (76. 80,178. 13)U/L]was higher than the group of mycoplasma pneumoniae pleuritis [ 55. 55 ( 42. 80, 79. 03 ) U/L ] and tuberculosis pleuritis [ 26. 50 (22. 05,50. 95)U/L]. The difference was statistically significant (P< 0. 01). The cut-off value of pleural effu-sion ADA for diagnosis of tuberculosis pleuritis is not available by application of ROC curve. Conclusion Higher ADA value is not only the characteristic of tuberculosis pleuritis,but also purulent pleuritis and mycoplas-ma pneumoniae pleuritis. ADA has no clinical value in diagnosis of tuberculosis pleuritis in children.

Pleuris associada à criptococose em cão: relato de caso / Pleurisy associated with cryptococcosis in a dog: case report

A Criptococose é uma importante doença infecciosa fúngica, causada por uma levedura do gênero Cryptococcus, que acomete diferentes espécies inclusive o homem. Há poucos relatos na literatura sobre a criptococose pulmonar em cães. O presente trabalho relata um caso de criptococose em um cão apresentando alterações respiratórias, especialmente dispneia. O diagnóstico foi realizado por meio da citologia aspirativa, após toracotomia exploratória, sendo observado um quadro de pleuris grave. O paciente foi tratado durante 90 dias com itraconazol e apresentou, ao final do tratamento, a remissão completa dos sintomas relatados...

Cryptococcosis is a major infectious disease caused by a yeast from the Cryptococcus genre which affects different species including humans. There are few reports related to pulmonary cryptococcosis in dogs. A case of Cryptococcosis in a dog showing dyspnea was described. The diagnosis was done by aspiration cytology after exploratory thoracotomy, and a picture of severe pleurisy was observed. The diagnosis was done by needle aspiration cytology after thoracotomy. Severe pleuris frame was observed. Treatment with itraconazole was performed for 90 days, and at the end of the treatment the dog presented complete remission of reported symptoms...

A cross-sectional prospective study of pleural effusion among cases of chronic kidney disease.

Background. Pleural effusions of diverse aetiologies are encountered in patients with chronic kidney disease (CKD). The objectives of the present study were to examine the frequency of occurrence, causes, clinical features and management strategies of pleural effusion in patients with CKD including renal transplant recipients. Methods. A prospective cross-sectional observational analysis of pleural effusion in adult patients with CKD (stages 3 to 5) attending the Departments of Nephrology and Respiratory Medicine of a tertiary care institution in Eastern India was performed over a period of one year (February 2010 to January 2011). Results. Pleural effusion was found in 29 out of 430 patients with CKD (6.7%) and in two out of 34 post-renal transplant recipients (5.9%) evaluated during the study period. The mean age was 37.35±1.8 (mean±SEM [standard error of mean]) with a male to female ratio of 2:1. Exudates and transudates were found in equal frequencies. Heart failure was the single most common cause (41.9%, 13 of 31). Tuberculosis (TB) (n=8, 25.8%) and uraemic effusions (n=6, 19.4%) were responsible for the majority of exudates. Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for nonheart failure aetiology. Conclusions. Symptomatic pleural effusion was present in a small proportion of 6.7%; (n=29) patients with CKD including post-renal transplant recipients. Heart failure, TB and uraemic effusions accounted for most of the cases. Differentiating TB from uraemic effusion requires a combined clinico-pathological approach and this differentiation is absolutely necessary for proper management.

Influence of tail biting on weight gain, lesions and condemnations at slaughter of finishing pigs / Influência do canibalismo de cauda no ganho de peso, lesões e condenações ao bate de suínos em terminação

The present study assessed the association of tail-biting lesions in finishing pigs with weight gain, occurrence of locomotion or respiratory disorders and abscesses during finishing period, and carcass condemnation at slaughter. The study was carried out on 4 different farms. For each animal with a tail biting lesion, two control pigs were selected. The total number of animals in the study was 312, with 104 of them being tail-bitten. Tail lesions were classified according to the degree of severity into four scores: score 0 -normal tail withou lesion; score 1-3 - increasing lesion severity, and score 4 - healed lesions. Overall, the occurrence of severe tail lesions (score 3) varied from 55 to 73% of tail-bitten pigs among farms. On all farms, healing of tail lesions was observed in 95% to 100% of the animals at the evaluation performed within 41-43 days after the commencement of the study. In two out of the four evaluated farms, pigs with score of 3 showed lower weight gain (P<0.05) compared with score 0 pigs. Before slaughter, the occurrence of locomotion problems and nodules/abscesses was associated (P<0.05) with the presence of tail-biting lesions. At slaughter, tail-biting lesions were associated (P<0.05) with the presence of abscesses, lung lesions (pleuritis and embolic pneumonia) or arthritis in carcasses. Carcass condemnation was associated with the presence of tail-biting lesions (P<0.05). Overall, carcass condemnation rate was 21.4%, of which animals with tail-biting lesions accounted for 66.7% of condemnations. Among the animals diagnosed with cannibalism at farm level, only two had not healed their lesions at slaughter. The fact that there were a lot of carcass condemnations, despite the fact that tail-bitten animals had no more active lesions, suggests that different situations may be observed between the field and slaughter, reinforcing the need to analyze pigs both at farm and slaughter to allow proper assessment of losses related to tail biting. Collectively, the observations of the present study show that complications associated with tail-biting found in slaughterhouses are probably underestimating field prevalence.

O presente estudo avaliou a associação das lesões de canibalismo de cauda em suínos de terminação com o ganho de peso, ocorrência de problemas locomotores ou respiratórios e abscessos durante a fase de terminação, e condenação de carcaças ao abate. O estudo foi realizado em quatro granjas comerciais de suínos. Para cada animal com lesão de canibalismo de cauda, outros dois suínos na mesma baia foram selecionados como controle, totalizando 312 animais avaliados. As lesões de cauda foram classificadas de acordo com o grau de severidade em quatro escores: score 0 - cauda normal, sem lesão; escores de 1 a 3 - de acordo com o aumento da severidade da lesão, e escore 4 - lesões cicatrizadas. No total, suínos com lesões severas (escore 3) corresponderam a 55-73% dos animais com lesão de caudofagia. Em todas as granjas, a cicatrização das lesões de cauda foi observada em 95% a 100% dos animais na avaliação realizada entre 41-43 dias após o início do estudo. Animais com escore 3 apresentaram menor ganho de peso (P<0,05) quando comparados com animais de escore 0, em duas das quatro granjas avaliadas. Antes do abate, a ocorrência de problemas locomotores e de nódulos/abscessos foi associada (P<0,05) com a presença de lesões de caudofagia. Ao abate, as lesões de canibalismo de cauda foram associadas (P<0,05) com a presença de abscessos, lesões pulmonares (pleurite e pneumonia embólica) ou artrite na carcaça. A condenação de carcaça foi associada com a presença de lesões de canibalismo de cauda (P<0,05). A taxa de condenação de carcaças foi de 21,4%, sendo que os animais com lesões de canibalismo de cauda corresponderam a 66,7% dessas condenações. Dos animais diagnosticados com canibalismo de cauda, somente dois apresentavam lesões ativas ao abate. O aumento do número de condenações no abate nos lotes estudados sugere que diferentes situações sanitárias podem ser observadas a campo e ao abate, reforçando a necessidade de analisar os animais na granja e ao abate, a fim de permitir uma avaliação precisa das perdas associadas ao canibalismo de cauda. Coletivamente, as observações do presente estudo sugerem que as complicações associadas com o canibalismo da cauda verificadas no abate provavelmente representam uma subestimativa da prevalência encontrada nas granjas.

Multi-antigen and antibody assays (Seva TB Elisa) for the diagnosis of tuberculous pleural effusion.

Objective: Prospective evaluation of inhouse developed SEVA TB ELISA using cocktail of Mycobacterial antigens ES-31 and EST-6(containing ES-38 and ES-41) and their specific antibodies in the diagnosis of Tuberculous pleural effusion was done in a tertiary care hospital. Methods: Detection of circulating free and immune-complexed (IC) antigens and antibody by sandwich and indirect peroxidase ELISA respectively was done in pleural fluid and sera specimens. Total 33 patients with pleural effusion, including 24 patients diagnosed as tuberculous pleural effusion based on clinico-radiological, microbiological and biochemical profile (protein, LDH and ADA) of pleural effusion and nine patients with non-tuberculous pleural effusion, were studied. Results: Pleural fluid showing either antigen or immune-complexed antigen or antibody positive was considered as ELISA positive for tuberculous pleural effusion. Multi antigen and antibody assay (SEVATB ELISA) showed 100% specificity and 83% sensitivity in pleural fluid while 78% specificity and 92% sensitivity in serum of tuberculous pleuritis patients. Conclusion: This study showed usefulness of SEVATB ELISA, using cocktail of ES-31 and EST-6 antigens and their antibodies for antibody and antigen detection respectively in analysis of either sera or pleural fluid samples of suspected tuberculous pleuritis patients as an adjunct test to clinical diagnosis.

Praziquantel Treatment of an Eosinophilic Pleuritis Patient Suspected to Be Due to Sparganum Infection / 감염과화학요법

Human sparganosis is caused by the larval tapeworm of genus Spirometra. This parasite commonly invades subcutaneous tissues and muscles. However, infection in the pleural cavity is rare. A 65-year-old male patient, who had undergone surgical excision of subcutaneous masses due to a parasite infection (presumed to have been sparganosis) approximately 10 years ago, showed pleural effusion and peripheral eosinophilia. The anti-sparganum specific IgG antibody levels in the serum and pleural fluid were significantly higher than the normal control levels. Three consecutive doses of praziquantel (75 mg/kg/day) were administered for control of pleural effusion and peripheral eosinophilia. In this patient, sparganosis was suspected, and the probable cause of the infection was ingestion of raw snakes and frogs. Immunoserologic tests using ELISA can be helpful in diagnosis of pleural sparganosis and praziquantel is suggested as an alternative treatment for surgically unresectable cases.

Drogas asociadas a enfermedad pleural / Associated drugs to pleural disease

Está bien documentado que las drogas pueden producir enfermedades de la pleura. Si bien hay alrededor de treinta drogas a las que se las relaciona claramente con afectación pleural, también hay que considerar que toda droga puede, potencialmente, comprometer la pleura y, si no hay otra causa evidente de enfermedad pleural, se debe tener presente esta causa. El daño puede darse en forma independiente en la pleura o coexistir con el del parénquima pulmonar. La mayoría de los casos se resuelve al suspender la droga y, en otras ocasiones, se deben agregar esteroides. En este artículo se realiza un agrupamiento de las drogas que producen esta patología, una descripción y las características de cada una de ellas, y el manejo terapéutico adecuado de las que más frecuentemente se hallan involucradas.

It's well known that drugs can produce pleural diseases. There are about thirty drugs which are associated with them, but any drug, potentially, may cause pleural disease. Pleural damage may happen as an independent form or coexists with pulmonary parenchyma injury. Most cases are resolute when drug is discontinued, but every times we have to add steroids. In this article we group them, their characteristics are described, and we give a treatment guide of more common drugs which cause pleural diseases.

The Relation of Residual Pleural Thickening with Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases of Pleural Effusion in Patients with Tuberculous Pleuritis / 결핵및호흡기질환

BACKGROUND: Residual pleural thickening (RPT) is the most frequent complication of tuberculous pleurisy (TP), and this can happen despite of administering adequate anti-tuberculous (TB) therapy. Yet there was no definite relation between RPT and other variables. The aim of this study was to examine matrix metalloproteinases (MMPs) and the inhibitors of metalloproteinases (TIMPs) and to identify the factors that can predict the occurrence of RPT. METHODS: The patients with newly-detected pleural effusions were prospectively enrolled in this study from January 2004 to June 2005. The levels of MMP-1, -2, -8 and -9, and TIMP-1 and -2 were determined in the serum and pleural fluid by ELISA. The residual pleural thickness was measured at the completion of treatment and at the point of the final follow-up with the chest X-ray films. RESULTS: The study included 39 patients with pleural fluid (PF). Twenty-three had tuberculous effusion, 7 had parapneumonic effusion, 7 had malignant effusion and 2 had transudates. For the 17 patients who completed the anti-TB treatment among the 23 patients with TP, 7 (41%) had RPT and 10 (59%) did not. The level of PF TIMP-1 in the patients with RPT (41,405.9+/-9,737.3 ng/mL) was significantly higher than that of those patients without RPT (29,134.9+/-8,801.8) at the completion of treatment (p=0.032). In 13 patients who were followed-up until a mean of 8+/-5 months after treatment, 2 (15%) had RPT and 11 (85%) did not. The level of PF TIMP-2 in the patients with RPT (34.4+/-6.5 ng/mL) was lower than that of those patients without RPT (44.4+/-15.5) at the point of the final follow-up (p=0.038). CONCLUSION: The residual pleural thickening in TP might be related to the TIMP-1 and TIMP-2 levels in the pleural fluid.

The significance of detecting interferon-?,adenosine deaminase and neopterin in the diagnosis of tuberculous pleural effusion / 重庆医科大学学报

Objective:To evaluate the significance of determination of the activity of adenosine deaminase(ADA),and the level of interferon(IFN-?) and neopterin(Npt) in the diagnosis of tuberculous pleuritis.Methods:Enzyme-linked immunosorbent assay(ELISA) and couple velocity assay were used to detect the activity of ADA,and the level of IFN-? and neopterin in 43 patients with tuberculous pleuritis and 38 patients with pleural effusion associated with malignant tumor or other causes and the receiver operating characteristic(ROC) curves were also protracted.Results:The activity of ADA,and the level of IFN-? and neopterin(P

A Case of allergic angitis and granulomatosis with manifestation of pleuritis and pericarditis / 천식및알레르기

Allergic angitis and granulomatosis is a kind of rare systemic vasculitis, with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system and hepatobiliary tract. There was no report of a case with manifestation of pleuritis and pericarditis, while several cases had been reported in Korea. So we here report a case of allergic angitis and granulomatosis with manifestations of pleuritis and pericarditis. The case also showed clinical manifestations of hypereosinophilia, asthma, rhinitis, pulmonary infilterates with eosinophilia and nephritis. Open lung biopsy showed arteritis with heavy infilteration of activated eosinophil in lung, pleura and pericardium. The involvement of heart might cause critical complication leading death. The patients who are supposed as allergic angitis and granulomatosis should be examined for the involvement of heart.

Effects of Millettia pulchra Extracts on TNF-?、PGE_2、NO in Pleuritis Model Rats / 中国药房

OBJECTIVE: To investigate the effect of Millettia pulchra extracts on tumor necrosis factor ? (TNF-?), prostaglandin E2(PGE2) and nitric oxide (NO) in pleuritis model rats. METHODS: 56 Wistar male rats were randomly divided into control group, model group, dexamethasone (DEX) group, water extract of M.pulchra (TYLS) group (high dose and low dose) and total flavonoids of M.pulchra(FYLS) group (high dose and low dose). After preoperational intragastric administration for 7 days, the pleuritis model was induced by injecting carrageenan into pleural cavity in 30 minutes after the last medication. The amounts of pleurorrhea, leucocyte, TNF-?,PGE2 and NO in the pleurorrhea were measured at 8 hours after modeling. RESULTS: As compared with the model group, in TYLS and FYLS group the pleurorrhea volume, leukocyte amount, contents of TNF-? and PGE2 reduced markedly, but the synthesis of NO had little change.CONCLUSION:M.pulchra Extracts show a marked inhibitive effect on pleuritis. Their anti-inflammation effects may be related to inhibiting the increase of TNF-? and the infiltration and transmigration of leucocytes, but not associate with the synthesis of NO.

Exploration of clinical diagnostic value of measuring sulfate glycosaminoglycan segment and antibody to tuberculosis in patients with hydrothorax / 重庆医科大学学报

Objective:To explore the clinical value of detection of sulfated glycosaminoglycan(GAG) segment and IgG antibody to tuberculosis(TB-IgG) to diagnose tuberculous pleuritis and malignant pleural effusion.Methods:Using the lung tumor antigen(LTA) diagnostic kit and tuberculosis antibody colloidal gold diagnostic kit to detecte the GAG and TB-IgG of serum and pleural fluid separately of 357 patients suffering from hydrothorax.We proceeded a retrospective study and then had statistical evidence.Results:The positive rate and specificity of GAG of pleural effusion of lung cancer patients were 80.3%(106/132),88.4%,and that of serum were 54.5%(72/132),90.2%.The positive rate and specificity of TB-IgG of pleural effusion of tuberculous pleuritis were 66.2%(102/154),86.2%,and that of serum were 33.8%(52/154),83.7%.The specificity of GAG,combined with TB-IgG by measuring the pleural fluid of tuberculous pleuritis and malignant pleural effusion would increase to 97.0% and 98.2% separately.Conclusion:Detection of GAG and TB-IgG of pleural fluid is helpul for diagnosis of tuberculous pleuritis and malignant pleural effusion.GAG combined with TB-IgG can act as differential diagnosis marker of tuberculous pleuritis and malignant pleural effusion for its higher specificity.