[Pleural effusion and pulmonary hypertension in a patient with Parkinson disease treated with cabergoline]. / Derrame pleural e hipertensión pulmonar en un paciente con enfermedad de Parkinson en tratamiento con cabergolina.

Cabergoline is a synthetic dopamine agonist used to treat Parkinson disease. The drug occasionally induces pleuropulmonary adverse effects, which manifest as pleural thickening or effusion, interstitial pneumonitis, pulmonary infiltrates, or fibrosis. We report a rare case of pleural effusion and severe pulmonary hypertension in a 79-year-old man with Parkinson disease who had been treated with cabergoline for 1 year. The symptoms disappeared 10 months after the drug was discontinued.

Derrame pleural e hipertensión pulmonar en un paciente con enfermedad de Parkinson en tratamiento con cabergolina / Pleural effusion and pulmonary hypertension in a patient with Parkinson disease treated with cabergoline

La cabergolina es un fármaco sintético dopaminérgico, que se utiliza en el tratamiento de la enfermedad de Parkinson y que rara vez produce efectos adversos pleuropulmonares, los cuales se manifiestan como engrosamiento o derrame pleurales, neumonitis intersticial, infiltrados pulmonares o fibrosis. Presentamos un caso excepcional en un varón de 79 años con enfermedad de Parkinson, tratado con cabergolina durante un año, que presentó un derrame pleural y grave hipertensión pulmonar, que desaparecieron a los 10 meses de la retirada de este fármaco(AU)

Cabergoline is a synthetic dopamine agonist used to treat Parkinson disease. The drug occasionally induces pleuropulmonary adverse effects, which manifest as pleural thickening or effusion, interstitial pneumonitis, pulmonary infiltrates, or fibrosis. We report a rare case of pleural effusion and severe pulmonary hypertension in a 79-year-old man with Parkinson disease who had been treated with cabergoline for 1 year. The symptoms disappeared 10 months after the drug was discontinued(AU)

[Influence of the method used to obtain pleural fluid on the determination of the Acid-base balance]. / Importancia de la forma de obtención del líquido en la determinación del equilibrio ácido-base pleural.

OBJECTIVE: To analyze the methods used in our hospital for obtaining pleural fluid to determine the acid-base balance and to evaluate the clinical repercussions of each method. METHODS: Initially we studied the methods used by physicians in our hospital to collect pleural fluid for determination of the acid-base balance. In a second phase, we performed a prospective, descriptive, comparative study with the participation of 71 patients with pleural effusions in order to compare the acid-base balance according to the technique used to obtain the fluid. RESULTS: Pleural fluid was obtained using 3 methods: a) direct extraction using a heparinized syringe (group 1); b) extraction using a 20 mL syringe with subsequent aspiration from this syringe into a heparinized syringe (group 2); and c) filling a heparinized syringe from the 20 mL syringe (group 3). The only significant differences between group 1 and groups 2 and 3 were an increase in the pleural PO2 and oxygen saturation. The difference in the mean pH between groups 1 and 2 was 0.009 (95% confidence interval: -0.39 to 0.02; P=.5) and between groups 1 and 3 was 0.007 (95% confidence interval: -0.38 to 0.023; P=.6). The correlations between findings for PO2, pH, and PCO2 obtained in the different groups were statistically significant, with values superior to .95 in the last 2 variables. CONCLUSIONS: Physicians who perform thoracentesis in our hospital use different methods for obtaining fluid to determine the pleural acid-base balance. The 3 methods analyzed show no significant differences with regard to pH or PCO2. Pleural fluid may be obtained by a single puncture with a large-volume syringe, subsequently transferring the fluid to a heparinized syringe without this significantly affecting the pH or PCO2, thus reducing the number of manipulations and the risk of complications.

[Influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid]. / Influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido pleural.

OBJECTIVE: To assess the influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid from patients with lymphocytic exudate. PATIENTS AND METHODS: A prospective, descriptive study was performed in 72 patients with pleural effusion who had lymphocytic exudate and in whom biopsy was indicated. Biochemical variables and cytology of pleural fluid were analyzed at baseline, 48 hours later (immediately prior to biopsy), and 48 hours after biopsy. RESULTS: The patients had a mean (SD) age of 63 (17) years, 57% were smokers, and 61% were men. Effusion was right-sided in 36% of patients, unilateral in 80%, and massive in 21%. The etiology was benign in 43 cases and neoplastic in 29 (40%). Pleural lactate dehydrogenase (LDH) was found to be increased following biopsy. This effect was significant in the overall population of 72 patients (649 [481] U/L just prior to biopsy and 736 [536] U/L 48 hours after biopsy; mean increase, 86 U/L; 95% confidence interval, 45-128 U/L; P< .001), in patients with pleural tumors (799 [529] U/L prior to biopsy and 957 [571] U/L 48 hours later, P< .001), and in those with LDH concentration greater than 266 U/L. CONCLUSIONS: The results of our study show that a single thoracentesis procedure does not alter biochemical parameters or pleural cytology after 48 hours in lymphocytic exudates. Pleural needle biopsy leads to a significant increase in the concentration of LDH in patients with pleural tumors or higher baseline concentrations of LDH. Thoracentesis, pleural biopsy, or a combination of the two do not lead to significant changes in the number of eosinophils in pleural fluid.

Influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido pleural / Influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid

Objetivo: Valorar la influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido en los pacientes con un exudado linfocitario. Pacientes y métodos: Se ha realizado un estudio prospectivo y descriptivo de 72 pacientes con derrame pleural que tenían un exudado linfocitario e indicación de biopsia. Se analizaron y compararon la bioquímica y citología del líquido pleural al inicio, a las 48 h de la punción (antes de la biopsia) y a las 48 h de la biopsia pleural. Resultados: Los pacientes tenían una edad media ± desviación estándar de 63 ± 17 años, el 57% eran fumadores y el 61%, varones. El derrame era derecho en un 36%, unilateral en un 80% y masivo en el 21%. La etiología era benigna en 43 casos y neoplásica en 29 (40%). La lactatodeshidrogenasa (LDH) pleural aumentó después de la biopsia en el análisis de todos los pacientes (649 ± 481 U/l antes de ésta y 736 ± 536 U/l a las 48 h; aumentó en promedio 86 U/l; intervalo de confianza del 95%, 45-128 U/l; p < 0,001), en los pacientes con neoplasia pleural (799 ± 529 U/l de LDH antes de la biopsia y 957 ± 571 U/l a las 48 h; p < 0,001) o valores de LDH superiores a 266 U/l. Conclusiones: Nuestro estudio demuestra que una única toracocentesis no modifica los valores de la bioquímica o la citología pleural a las 48 h en los exudados linfocitarios. La biopsia pleural transparietal aumenta de forma significativa los valores de la LDH en los pacientes con neoplasia pleural o valores iniciales de LDH más elevados. La realización de la toracocentesis, la biopsia pleural o ambas técnicas no modifica de forma significativa el número de eosinófilos del líquido pleural

Objective: To assess the influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid from patients with lymphocytic exudate. Patients and methods: A prospective, descriptive study was performed in 72 patients with pleural effusion who had lymphocytic exudate and in whom biopsy was indicated. Biochemical variables and cytology of pleural fluid were analyzed at baseline, 48 hours later (immediately prior to biopsy), and 48 hours after biopsy. Results: The patients had a mean (SD) age of 63 (17) years, 57% were smokers, and 61% were men. Effusion was right-sided in 36% of patients, unilateral in 80%, and massive in 21%. The etiology was benign in 43 cases and neoplastic in 29 (40%). Pleural lactate dehydrogenase (LDH) was found to be increased following biopsy. This effect was significant in the overall population of 72 patients (649 [481] U/L just prior to biopsy and 736 [536] U/L 48 hours after biopsy; mean increase, 86 U/L; 95% confidence interval, 45-128 U/L; P<.001), in patients with pleural tumors (799 [529] U/L prior to biopsy and 957 [571] U/L 48 hours later, P<.001), and in those with LDH concentration greater than 266 U/L. Conclusions: The results of our study show that a single thoracentesis procedure does not alter biochemical parameters or pleural cytology after 48 hours in lymphocytic exudates. Pleural needle biopsy leads to a significant increase in the concentration of LDH in patients with pleural tumors or higher baseline concentrations of LDH. Thoracentesis, pleural biopsy, or a combination of the two do not lead to significant changes in the number of eosinophils in pleural fluid