Background: Standard treatment for pleural infection includes of drainage and antibiotics. Chest tube drainage often fails if the fluid is loculated by fibrinous adhesions. Intrapleural fibrinolysis may facilitate pleural drainage. Objective: To evaluate the role of Streptokinase (STK) in the treatment of empyema and exudative pleural effusions. Subjects and method: A study included 34 patients (21 patients with exudative pleural effusions, 13 patients with empyema), aged 15-77 years. All patients received intrapleural STK daily with dose of 300.0000-500.000 UI for empyema and 300.000 UI for exudative pleural effusions. Response was assessed by clinical outcome, pleural fluid drainage, chest radiography, pleural ultrasound. Results: Mean pleural fluid drainage after STK instillation was higher in all patients. Pleural fluid drainage was 640 \xb1 494 ml before STK instillation and 823 \xb1 755 ml after STK instillation for empyema; 765 \xb1 691 ml before STK instillation and 1,033 \xb1 757 ml after STK instillation for exudative pleural effusions. The success rate of clinical outcome was 100%. Only 2 patients required decortications. Fever occurred in 3 patients (8.8%) and allergy in 1 patient (3%). Conclusions: Intrapleural STK was safe and effective in the treatment of empyema and exudative pleural effusions. STK prevents pleural adhesions and reduces the risks for surgery.
Streptokinase/ therapeutic use ; Empyema ; Pleural/therapy ; Pleural Effusion/ therapy

Background: A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption. It is the most common manifestation of pleural disease. Objective: To evaluate the etiological, clinical, subclinical characteristics and treatment results of patients with pleural effusions. Subjects and method: This was a retrospective, descriptive study on 768 patients with pleural effusion, who were treated in Department of Respiratory of Bach Mai Hospital, from January 2001 to October 2003. The information was taken from clinical records of patients. Results and conclusions: The causes of pleural effusion were tuberculosis 37.6%, lung cancer 23.8%, pneumonia or lung abscess 8.0%, chronic heart failure disease 7.1%, liver cirrhosis 3.5%, others causes 6.7% of cases. The patients presented with chest pain 81.6%, dyspnea 75.1%, cough 43.8%, expectoration 29.7%, and fever 54.8%, pleural effusion syndrome 92.2% of cases. On chest X-ray images, 75.3% of cases had Damoiseau curve. Pleural ultrasound demonstrated free pleural effusion in 63.8% of cases, loculated pleural effusion and pleural compartmentalization in 19.8%. Rivalta test of pleural fluid was positive in 83.7% of cases, negative in 13.7%. Malignant cells found in pleural fluid of 21.2%. Histology of pleural biopsies demonstrated malignant in 17.4% of cases; in which mesothelioma 4.0%, pleural tuberculosis 30.5%; others 52.1%. After the treatment, recovery accounted for 6.3% of cases, amelioration 58.3%, and no amelioration 37.4%. 66.9% of cases were performed therapeutic thoracocentesis, 2.7% were performed pleural lavage.
Pleural Effusion/ therapy ; pathology ; diagnosis

No abstract available.
Cisplatin* ; Cytarabine* ; Drug Therapy* ; Pleural Effusion, Malignant*

Malignant pleural effusion in multiple myeloma (MM) is extremely rare and is associated with poor prognosis. We experienced two cases of MM IgA type with malignant pleural effusion. The diagnoses were based on characteristic cytology and CD138 immunocytochemistry. The patients received several cycles of combination chemotherapy, since symptoms were more aggressive with an uncontrolled pleural effusion. We review the clinical features of these cases and literature concerning myelomatous pleural effusion.
Drug Therapy, Combination ; Humans ; Immunoglobulin A ; Immunohistochemistry ; Multiple Myeloma ; Pleural Effusion ; Pleural Effusion, Malignant ; Prognosis

BACKGROUND: It is said that tuberculous pleuritis responds well to anti-tuberculous drug in general, so no further aggressive therapeutic management is unnecesarry except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who need later decortication due to dyspnea caused by pleural loculation or thickening despite several months of anti-tuberculous drug therapy. Therefore, we want to know the clinical difference between a group who received decortication due to complication of tuberculous pleuritis despite of anti-tuberculous drug and a group who improved after 9 months of anti-tuberculous drug only. METHODS: We reviewed 20 tuberculous pleuritis patients(group 1) who underwent decortication due to dyspnea caused by pleural loculation or severe pleural thickening despite of anti-tuberculous drug therapy for 9 or more months, and 20 other tuberculous pleuritis patients(group 2) who improved by anti-tuberculous drug only and had similar degrees of initial pleural effusion and similar age,sex distribution. Then we compared between the two groups the duration of symptoms before anti-tuberculous drug treatment and pleural fluid biochemistry like glucose, LDH, protein and pleural fluid cell count and WBC differential count, and we also wanted to know whether there was any difference in preoperative PFT value and postoperative PFT value in the patients who underwent decortication, and obtained following results. RESULTS: 1) Group 1 patients had lower glucose level{63.3+/-30.8(mg/dl)} than that of the group 2{98.5+/-34.2(mg/dl), p<0.05}, and higher LDH level{776.3+/-266.0(IU/L)} than the group 2 patients{376.3 +/-123.1(IU/L), p<0.05), and also longer duration of symptom before treatment{2.0+/-1.7(month)} than the group 2{ 1.1 +/-1.2(month), p<0.05)}, respectively. 2) In group 1, FVC changed from preoperative 2.55+/-0.80(L) to postoperative 2.99+/-0.78(L)(p<0.05), and FEV1 changed from preoperative 2.19 +/- 0.70(L/sec) to postoperative 2.50+/-0.69(L/sec) (p<0.05). 3) There was no difference in pleural fluid protein level(5.05+/-1.01(gm/dL) and 5.15+/-0.77 (gm/dl), p>0.05) and WBC differential count between group 1 and group 2. CONCLUSION: It is probable that in tuberculous pleuritis there is a risk of complication in the case of showing relatively low pleural fluid glucose or high LDH level, or in the case of having long duraton of symptom before treatment. We thought prospective study should be performed to confirm this.
Biochemistry ; Cell Count ; Drug Therapy ; Dyspnea ; Glucose ; Humans ; Pleural Effusion* ; Pleurisy ; Prospective Studies ; Tuberculosis, Pleural*

BACKGROUND: Traditionally, tuberculous pleurisy has been known to largely develop as primary tuberculosis. However, as the incidence of tuberculosis decrease, recent studies have shown reactivation tuberculosis has become the main cause of tuberculous pleurisy. METHODS: 141 cases of tuberculous pleurisy, between January 2003 and February 2006, at the Dankook university hospital. were retrospectively studied. The patients were divided into primary and reactivation tuberculosis. based on the history and radiological characteristics, and the clinical, radiological characteristics at the time of diagnosis and residual pleural thickening after 6 month of chemotherapy were compared between the two groups. RESULTS: 1. Of the 141 tuberculous pleurisy cases, in 135 it was possible to differentiate between primary and reactivation tuberculosis. 2. Of the 135 tuberculous pleurisy cases, 38 (28%) showed a primary tuberculosis pattern, and 98 (72%) showed a reactivation tuberculosis pattern. 3. There were no significant differences between primary and reactivation tuberculosis in relation to age, sex, duration of symptom, amount of pleural effusion, pleural fluid WBC, lymphocyte count, and level of protein, LDH and ADA at the time of diagnosis. 4. 124 patients were followed for 6 months after diagnosis of tuberculous pleurisy, and there was no significant difference in the residual pleural thickening between primary and reactivation tuberculosis. CONCLUSION: In South Korea, a reactivation disease is currently a more common cause of tuberculous pleurisy than a primary disease. There was no difference in the clinical characteristics between primary and reactivation tuberculosis.
Diagnosis ; Drug Therapy ; Humans ; Incidence ; Korea ; Lymphocyte Count ; Pleural Effusion ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pleural*

BACKGROUND: The routine application of the combined regimen of corticosteroid-antituberculosis therapy to the tuberculous pleurisy remains controversial. Steroid therapy to tuberculous pleurisy could be effective on the acceleration of absorption of pleural effusion and symptom improvement, but there has been debate about the effect of prednisolone on the prevention of pleural adhesion. So we studied the efficacy of combined regimen of prednisolone-antituberculosis therapy on the absorption of pleural effusion and prevention of pleural adhesion. METHODS: A prospective, randomized study was performed in 82 patients, 50 patients(non-steroid group) were treated with only antituberculosis regimen for 6 months and in 32 patients(steroid group) prednisolone(30mg/day) were administered in addition to antituberculosis regimen for one months and tapered for another month. The amount of pleural effusion was compared at the beginning of treatment, 2nd month, 6th month and final visit with chest X-ray findings which were graded from grade 0(complete absorption) to grade 6(near total haziness). RESULTS: The amount of pleural effusion of steroid group at 2nd month, 6th month and final visit was lesser than that of non-steroid group (P<0.05). The incidence of the complete absorption of the pleural effusion was 3/32(9.4%) in steroid group, 1/50(2%) in non-steroid group at 2nd month after treatment; and 12/32(37.5%) in steroid group, 6/50(12%) in non-steroid group at 6th month after treatment (P<0.05). At final observation, the incidence of residual pleural thickening was 15/32(47%) in steroid group and 37/50(74%) in non-steroid group (P<0.05). No serious side effects were noted during the treatment with prednis olone. CONCLUSION: The administration of prednisolone in conjunction with antituberculosis chemotherapy improved the absorption of pleural effusion and decreased the residual pleural thickening.
Absorption ; Acceleration ; Drug Therapy ; Humans ; Incidence ; Pleural Effusion ; Prednisolone* ; Prospective Studies* ; Thorax ; Tuberculosis, Pleural*

BACKGROUND: The routine application of the combined regimen of corticosteroid-antituberculosis therapy to the tuberculous pleurisy remains controversial. Steroid therapy to tuberculous pleurisy could be effective on the acceleration of absorption of pleural effusion and symptom improvement, but there has been debate about the effect of prednisolone on the prevention of pleural adhesion. So we studied the efficacy of combined regimen of prednisolone-antituberculosis therapy on the absorption of pleural effusion and prevention of pleural adhesion. METHODS: A prospective, randomized study was performed in 82 patients, 50 patients(non-steroid group) were treated with only antituberculosis regimen for 6 months and in 32 patients(steroid group) prednisolone(30mg/day) were administered in addition to antituberculosis regimen for one months and tapered for another month. The amount of pleural effusion was compared at the beginning of treatment, 2nd month, 6th month and final visit with chest X-ray findings which were graded from grade 0(complete absorption) to grade 6(near total haziness). RESULTS: The amount of pleural effusion of steroid group at 2nd month, 6th month and final visit was lesser than that of non-steroid group (P<0.05). The incidence of the complete absorption of the pleural effusion was 3/32(9.4%) in steroid group, 1/50(2%) in non-steroid group at 2nd month after treatment; and 12/32(37.5%) in steroid group, 6/50(12%) in non-steroid group at 6th month after treatment (P<0.05). At final observation, the incidence of residual pleural thickening was 15/32(47%) in steroid group and 37/50(74%) in non-steroid group (P<0.05). No serious side effects were noted during the treatment with prednis olone. CONCLUSION: The administration of prednisolone in conjunction with antituberculosis chemotherapy improved the absorption of pleural effusion and decreased the residual pleural thickening.
Absorption ; Acceleration ; Drug Therapy ; Humans ; Incidence ; Pleural Effusion ; Prednisolone* ; Prospective Studies* ; Thorax ; Tuberculosis, Pleural*

The purpose of this study was to propose that intrapleural urokinase (UK) instillation could reduce pleural thickening in the treatment of loculated tuberculous pleural effusion. Forty- three patients who were initially diagnosed as having loculated tuberculous pleural effusion were assigned at random to receive either the combined treatment of UK instillation including anti-tuberculosis agents (UK group, 21 patients) or strictly the unaccompanied anti-tuberculous agents (control group, 22 patients). The UK group received 100, 000 IU of UK dissolved in 150 ml of normal saline daily, introduced into the pleural cavity via a pig-tail catheter. The control group was treated with anti-tuberculous agents, excepting diagnostic thoracentesis. After the cessation of treatment, residual pleural thickening (RPT) was compared between the two groups. Clinical characteristics and pleural fluid biochemistry were also evaluated. The RPT (4.59 +/-5.93 mm) of the UK group was significantly lower than that (18.6 +/-26.37 mm) of the control group (p< 0.05). The interval of symptoms observed prior to treatment of patients with RPT > or = 10 mm (6.0 +/- 3.4 wks) was detected to be significantly longer than in those with RPT< 10 mm (2.1 +/- 1.2 wks) in the control group (p< 0.05). However, there were no discernible differences were seen in the pleural fluid parameter in patients with RPT > or = 10 mm, as compared to patients with RPT< 10 mm in the UK group. These results indicate that the treatment of loculated tuberculous pleural effusion with UK instillation via percutaneous transthoracic catheter can cause a successful reduction in pleural thickening.
Adult ; Catheterization ; Female ; Humans ; Male ; Pleural Effusion/*drug therapy ; Prospective Studies ; Tuberculosis, Pleural/*drug therapy ; Urinary Plasminogen Activator/*administration & dosage

Malignant pleural mesothelioma (MPM) is a pleura-derived malignant tumor, with a gradually increasing incidence in recent years based on domestic and foreign epidemiologic data. Most patients with MPM are diagnosed at an advanced stage due to its insidiousness and aggressiveness. The therapeutic strategies of MPM mainly include surgery, chemotherapy and radiotherapy. Recently, the immunotherapy has altered the treatment pattern and further improved the survival of these patients. In order to timely present the domestic and foreign progress in the diagnosis and treatment of MPM, and to further improve the level of standardized diagnosis and treatment in MPM in China, this guideline was formulated on the basis of existing clinical research evidence combined with experts' opinions. The guideline covers the epidemiology, diagnosis, pathology, treatment and follow-up of MPM.
China ; Humans ; Immunotherapy ; Lung Neoplasms/therapy* ; Mesothelioma/therapy* ; Mesothelioma, Malignant ; Pleural Neoplasms/therapy*