[Differential diagnosis between exudate and transudate in pleural effusion]. / Criterios diagnósticos para diferenciar trasudados de exudados en líquido pleural.

The objective was 1) to determine the usefulness of different criteria in the differential diagnosis between exudate and transudate in pleural effusion, 2) to evaluate albumin gradient changes in pleural effusion fluids characterized as transudates in patients who do and do not receive diuretic therapy, 3) to define the specificity of pleural effusions of neoplastic etiology. All patients with pleural effusion admitted to the hospital between January 15 and August 15 1994 were evaluated consecutively. Serum and pleural effusion, total protein, LDH, albumin and cholesterol levels were measured and the etiologic diagnosis of the pleural effusion (gold standard) was established. Out of the total of 112 evaluated patients, 7 were excluded because it was impossible to reach a final diagnosis. Based on the etiologic diagnosis, 47 patients (44.8%), average age of 69.6 +/- 12.07, had pleural effusions defined as transudate and 58 patients (55.2%), average age of 66.5 +/- 14.26, had pleural effusions defined as exudate. Sixty-six percent of the transudates were secondary to heart failure, while 40% of the exudates were of neoplastic origin. Using the criteria of Light et al, we obtained a diagnostic accuracy (DA) of 82.7% (CI 95% 73.1-90.0)%. However, when the cut-off point was modified according to Valdez and the value of cholesterol in pleural effusion and its relation to serum cholesterol was added, the DA rose to 90.2 (83.2-96.0)% (p < 0.05). The effusion-serum cholesterol ratio demonstrated 100 (85.1-100)% sensitivity for neoplastic effusions, whereas for non-neoplastic exudative effusions the sensitivity was 89 (73.2-96.8)%. The tests, however, showed only 17.4 (6.56-33.6)% specificity. The albumin gradient (the difference between serum and pleural effusion albumin) did no vary in patients with transudates who received diuretics, allowing a correct diagnosis of transudate in 93 (82.4-97.8)% of the cases. However, in patients who were taking diuretics, the classic criteria of protein index defined correctly only 66 (53.4-82.1)% of the cases (p < 0.05). It can be concluded that the variation of cut-off points originally established by Light et al. and the addition of cholesterol determination in pleural effusion and its relation to the serum cholesterol level allowed us to increase the DA. This appears to be the best way to differentiate a transudate from an exudate. The relation between pleural effusion and serum cholesterol levels showed a very low specificity for the differentiation of neoplastic and non-neoplastic exudative pleural effusions. Unlike the pleural effusion-serum total protein ratio, the albumin gradient allowed us to establish the correct diagnosis of transudate even in patients taking diuretics.

[Tuberculous pericarditis: diagnostic value of adenosine deaminase]. / Péricardite tuberculeuse: valeur diagnostique de l'adénosine désaminase.

Adenosine desaminase activity was measured in the pericardiac fluid of 35 patients with pericarditis of undetermined origin who were operated upon for diagnostic or therapeutic purposes. The causes of pericarditis fell into 6 categories: I, tuberculosis (8 cases); II, idiopathy (17 cases); III, neoplasia (6 cases); IV, purulent bacterial infection (2 cases); V, constriction (2 cases) and VI, radiotherapy (1 case). The highest mean adenosine desaminase value (143 U/l) was found in group I. Other values were 34 in group II, 48 in group III and 45 in groups IV to VI. There was a statistically significant difference in this respect between group I and the other groups (P less than 0.0001). If 60 U/l is taken as discriminant value for the diagnosis of tuberculous pericarditis, then the adenosine desaminase value has a 100 percent sensitivity and an 80 percent specificity. Measuring this value therefore is a very promising procedure.

Lemierre's disease: postanginal bacteremia and pulmonary involvement caused by Fusobacterium necrophorum.

The combination of acute pharyngotonsillitis, neck pain, fever, and pulmonary septic emboli caused by Fusobacterium necrophorum in a healthy young person is extremely rare. The entity was described by Lemierre in 1936 as a typical syndrome easy to recognize and diagnose exclusively on clinical grounds. A case of Lemierre's disease is reported, and 10 other cases found in the medical literature are reviewed.

Zinc, copper and ceruloplasmin in arteriosclerosis.

High serum levels of Zn, Cu and Ceruloplasmin were found in 13 patients with arteriosclerosis when compared with controls. The Zn/Cu ratio is much higher in arteriosclerotic patients than in healthy subjects.