Diagnostic Accuracy with Total Adenosine Deaminase as a Biomarker for Discriminating Pleural Transudates and Exudates in a Population-Based Cohort Study.

BACKGROUND: An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. OBJECTIVES: To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates. METHODS: An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study. RESULTS: 157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, n = 33/157) was congestive heart failure (79%, 26/33) and that among exudate samples (71%, n = 124/157) was tuberculosis (28.0%, 44/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different (P < 0.0001) between both total exudates (18.4 U/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0 U/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; P < 0.001), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0 U/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; P < 0.0001). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, P < 0.05). CONCLUSIONS: P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.

Increased Cytokeratin 19 Fragment Levels Are Positively Correlated with Adenosine Deaminase Activity in Malignant Pleural Effusions from Adenocarcinomas.

Adenosine deaminase (ADA) and cytokeratin 19 (CK19) are known pleural biomarkers. Although ADA in humans functions mainly in the immune system, it also appears to be associated with the differentiation of epithelial cells. Keratin filaments are important structural stabilizers of epithelial cells and potent biomarkers in epithelial differentiation. This study aimed to investigate the simultaneous presence of the ADA enzyme and CK19 fragments to assess epithelial differentiation in malignant and benign pleural fluids. Diagnosis of the cause of pleural effusion syndrome was confirmed by means of standard examinations and appropriate surgical procedures. An ADA assay, in which ADA irreversibly catalyzes the conversion of adenosine into inosine, was performed using a commercial kit. The CK19 assay was performed using a CYFRA 21-1 kit, developed to detect quantitative soluble fragments of CK19 using an electrochemiluminescence immunoassay. One hundred nineteen pleural fluid samples were collected from untreated individuals with pleural effusion syndrome due to several causes. ADA levels only correlated with CK19 fragments in adenocarcinomas, with high significance and good correlation (rho = 0.5145, P = 0.0036). However, further studies are required to understand this strong association on epithelial differentiation in metastatic pleural fluids from adenocarcinomas.

Biomarcadores tumorais pleurais na prática clínica: úteis? Inúteis? Incompreendidos? / Pleural tumor markers in clinical practice: useful? Useless? Misunderstood?

Os biomarcadores tumorais dosados no líquido pleural possuem relevância estatística e clínica para serem utilizados como sugestão do diagnóstico diferencial entre derrames pleurais malignos e benignos nos casos onde os primeiros resultados da citopatologia e histopatologia são ambos inconclusivos AU

Tumor biomarkers measured in pleural fluid have statistical and clinical relevance for use as a suggestion of differential diagnosis between benign and malignant pleural effusions in cases where the first results of cytopathology and histopathology are both inconclusive AU.

Combined evaluation of adenosine deaminase level and histopathological findings from pleural biopsy with Cope's needle for the diagnosis of tuberculous pleurisy.

INTRODUCTION: Closed needle pleural biopsy (CNPB) has historically been the gold standard procedure for the diagnosis of pleural tuberculosis. Adenosine deaminase (ADA) is an efficient biomarker for tuberculosis that is measurable in pleural fluids. OBJECTIVE: We compared the diagnostic accuracy of the pleural ADA (P-ADA) level and histopathological findings of CNPB specimens in patients with pleural tuberculosis. METHODS: This prospective study consisted of two groups of examinations with a proven diagnosis of pleural effusion. The P-ADA level was measured in 218 patients with pleural effusion due to a number of causes, and 157 CNPB specimens underwent histopathological analysis. RESULTS: CNPBs were performed in patients with tuberculosis (n=122) and other diseases: adenocarcinoma (n=23), lymphoma (n=5), systemic lupus erythematosus (n=4), squamous cell carcinoma (n=2), and small cell lung cancer (n=1). According to the ROC curve, the optimal cut-off value of the P-ADA level (Giusti and Galanti colorimetric method) was equal to or greater than 40.0 U/L. The diagnostic accuracy of the P-ADA test was 83.0%, and that of histopathological examination of the CNPB tissue, was 78.8% (AUC=0.293, P=0.7695). The association between the P-ADA assay and pleural histopathology was 24.41 (P<0.0001). The tetrachoric correlation coefficient was 0.563 (high correlation). CONCLUSION: In Brazil and other countries with a high incidence of tuberculosis, P-ADA activity is an accurate test for the diagnosis of tuberculous pleural effusions, and its use should be encouraged. The high diagnostic performance of the P-ADA test could to aid the diagnosis of pleural tuberculosis and render CNPB unnecessary.

Biomarcadores diagnósticos de tuberculose em pleurologia / Diagnostic biomarkers of tuberculosis in pleurologia

Atualmente o diagnóstico de tuberculose pleural pode ser realizado com a dosagem de biomarcadores diagnósticos no líquido pleural, especificamente com a dosagem da enzima adenosina desaminase. Os quadros clínico, laboratorial, imagem e citopatologia sugestivos sempre devem ser valorizados no conjunto do diagnóstico. Tal abordagem elege somente o procedimento de toracocentese como necessário para início do diagnóstico. Na maioria das apresentações clínicas, procedimentos cirúrgicos mais invasivos (biopsias pleurais), com complicações potencialmente fatais, não precisam ser realizados para exame histopatológico

Currently the diagnosis of pleural tuberculosis can be performed with the dosage of diagnostic biomarkers in pleural fluid, specifically the enzyme adenosine deaminase. The clinical, imaging and cytology suggestive should always be valued in the set of diagnosis together laboratory measurements. This approach selects only a thoracentesis procedure for early diagnosis. In most clinical presentations, more invasive surgical procedures (pleural biopsies) with life-threatening complications for histopathological examination

Computed tomography findings in patients with tracheal paracoccidioidomycosis.

OBJECTIVE: To evaluate the high-resolution computed tomographic (CT) findings of patients with tracheal paracoccidioidomycosis. METHODS: The high-resolution CT scans of 178 patients with pulmonary paracoccidioidomycosis were reviewed, and 4 cases of proven tracheal involvement were studied. There were 3 male and 1 female patients, with ages ranging from 44 to 62 years (average, 49.2 years). The CT scans were retrospectively analyzed with special attention to the location of airway lesions, patterns of wall thickening, and occurrence of abnormal adjacent lymph nodes. Images were reviewed by 2 radiologists who reached decisions by consensus. RESULTS: The CT findings were circumferential parietal thickening (n = 4) and irregular (n = 3) or smooth (n = 1), with submucosal nodules (n = 2). Enlarged mediastinal lymph nodes were seen in 1 patient. CONCLUSIONS: The CT findings in patients with tracheal paracoccidioidomycosis were circumferential irregular thickening of the tracheal wall, with submucosal nodules.

[Diffuse abnormalities of the trachea: computed tomography findings]. / Alterações difusas da traquéia: aspectos na tomografia computadorizada.

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

Alterações difusas da traquéia: aspectos na tomografia computadorizada / Diffuse abnormalities of the trachea: computed tomography findings

O objetivo deste ensaio pictórico foi apresentar as principais alterações tomográficas observadas em doenças que acometem a traquéia de forma difusa. As doenças estudadas foram amiloidose, traqueobroncopatia osteocondroplástica, traqueobroncomegalia, papilomatose laringo-traqueo-brônquica, linfoma, neurofibromatose, policondrite recidivante, granulomatose de Wegener, tuberculose, paracoccidioidomicose e traqueobroncomalácia. O principal aspecto observado na tomografia computadorizada foi o espessamento das paredes traqueais, com ou sem nodulações, calcificações parietais ou comprometimento da parede posterior. Embora a tomografia computadorizada permita a detecção e a caracterização das doenças das vias aéreas centrais, e a correlação com os dados clínicos reduza as possibilidades diagnósticas, a broncoscopia com biópsia continua sendo o procedimento mais importante no diagnóstico das lesões difusas da traquéia.

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

Vulnerabilidade ao HIV em profissionais integrantes de um programa de promocao de saude na regiao serrana do estado do Rio de Janeiro / HIV vulnerability among professionals members of an health promotion program in highland region of Rio de Janeiro

O presente estudo buscou levantar os aspectos abordados nas atividades de promocao de saude e prevencao das DSTs/Aids por profissionais de saude, integrantes do Programa Saude na Escola, na regiao serrana do estado do Rio de Janeiro e os metodos didatico-pedagogicos por eles utilizados, alem de realizar o levantamento de riscos relacionados a exposicao sexual desses profissionais, identificar a auto-avaliacao de vulnerabilidade e realizacao de sorologia anti-HIV pelos profissionais em questao. Os dados foram coletados atraves de formulario individual durante o mes de janeiro de 2005. Pode-se observar que os profissionais participantes do estudo abordam com frequencia as formas de transmissao das DSTs/aids e a importancia do uso do preservativo, mas essa frequencia diminui quando se trata de ensinar e demonstrar como utiliza-lo. Questoes relacionadas a vulnerabilidade e diferencas de genero frente a infeccao pelo HIV tambem nao sao discutidas com tanta frequencia. Predominam as estrategias didatico-pedagogicas convencionais como palestras e projecao de videos. Observou-se que parte dos profissionais nunca utilizava o preservativo e as relacoes estaveis, o sentimento de confianca e a fidelidade apareceram como razoes para nao utilizacao da camisinha. Percebeu-se tambem que a autopercepcao de risco ao HIV e subestimada por parte dos profissionais entrevistados. Fica claro que a adocao de comportamentos protetores nao esteve associada ao nivel de informacao sobre prevencao , mas envolve uma diversidade de aspectos bio-psico-sociais e comportamentais, que devem ser constantemente trabalhados, inclusive entre os profissionais de saude

Estudo retrospectivo da irrigação pleural peroperatória nos traumatismos tóraco-abdominais penetrantes com lesão de víscera oca abdominal / A retrospective study of perioperative pleural irrigation in the thoraco-abdominal trauma with penetrating abdominal injury hollow viscera

Realizado estudo retrospectivo no Hospital Universitário Antonio Pedro, no período compreendido entre janeiro de 1990 a dezembro de 1995, com o objetivo de avaliar a eficácia da irrigação pleural peroperatória em vítimas de traumatismos tóraco-abdominal penetrante e lesão de víscera oca abdominal associada. Trinta e um pacientes foram divididos em dois grupos assim discriminados: grupo I, constituído de vinte pacientes, no qual foi realizada irrigação pleural peroperatória com soro fisiológico e um outro denominado grupo II, constituído de onze pacientes no qual não foi realizado a irrigação pleural. Pesquisamos ainda os dados relativos à idade, sexo, agente agressor, lesões associadas, condições hemodinâmicas à admissão, localização e extensão da lesão do diafragma, lado afetado, número de lesões diafragmáticas, vísceras abdominais lesadas, índice de trauma abdominal (PATI), métodos de irrigação pleural, tempo de internação e evolução pós-operatória. Observamos que nove pacientes do grupo II e um do grupo I evoluíram com empiema pleural. Após análise de nossos resultados concluímos que a irrigação pleural per operatória foi fator importante na profilaxia desta complicação.