Diagnostic utility of eosinophils in the pleural fluid.

This study was conducted to assess the prevalence of eosinophilia in 358 consecutive samples of pleural fluid (all cases corresponded to first thoracentesis), to review the cause of eosinophilic pleural effusions, and to determine whether the presence of eosinophils increases the likelihood of nonmalignant underlying disorders. Eosinophilic pleural effusions were identified in 45 patients (12.6%): malignant underlying conditions were diagnosed in 11 patients (24.4% with eosinophilic effusions) and benign aetiologies were found in 27 patients. Benign aetiologies included uncomplicated paraneumonic effusion in 10 patients, tuberculosis in seven, complicated paraneumonic in five, liver cirrhosis in three, hydronephrosis in one and pulmonary thromboembolism in one. Seven pleural effusions were idiopathic. There was no difference in the prevalence between eosinophilic and noneosinophilic effusions according to the different diagnoses. With parameters of sensitivity, specificity, pretest and post-test probability and positive and negative predictive values for any prevalence figure using the Bayes' theorem and for any value of eosinophils (both in percentage or absolute numbers) in the pleural fluid (receiver operating characteristic curve) an adequate predictor of benign disease was not found. It is concluded that pleural eosinophilia at the initial thoracentesis cannot be considered as a predictor of an underlying benign disorder.

[Fiber bronchoscopy in lung cancer: relationship between radiology, endoscopy, histology and diagnostic value in a series of 1801 cases]. / Fibrobroncoscopia en el cáncer de pulmón: relación entre radiología, endoscopia, histología y rendimiento diagnóstico en una serie de 1.801 casos.

A retrospective analysis of 1,801 patients with primary pulmonary neoplasm diagnosed by fiber bronchoscopy between 1977 and 1992 was carried out in order to determine the relation between chest X-rays and endoscopic and histological findings, as well as to assess the diagnostic usefulness of the various endoscopic techniques used. Central tumors numbered 1,598 and peripheral ones 203. The largest tissue classification was squamous (39%) and the most common X-ray finding was pulmonary mass (40%). Endoscopy showed neoplastic infiltration in 49% of the cases and endobronchial tumor in 27%. X-rays showing pulmonary mass, hilar involvement and atelectasis were more often associated with infiltration, tumor and necrosis and with a small-cell tissue type. Bronchial biopsy gave the best diagnostic results in these cases. In cases of solitary pulmonary nodule and pleural effusion, on the other hand, normal endoscopic results with non-specific changes or extrapulmonary involvement, predominated, with adenocarcinoma and non-small cell tissue types. Transbronchial biopsy, especially with radioscopic monitoring, was most useful in these cases. We conclude that chest X-rays and endoscopic results can be used to predict the most likely tissue type in lung cancer and that they can serve as guides for the choice of diagnostic technique.

[Tetracycline pleurodesis for treatment of malignant pleural effusions. Retrospective study of 91 cases]. / Pleurodesis con tetraciclinas en el tratamiento del derrame pleural maligno. Estudio retrospectivo de 91 casos.

BACKGROUND: Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method. METHODS: Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method. RESULTS: 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months. CONCLUSIONS: Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.