Journal ArticleDOI
Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions.
Carmen Alemán,José Alegre,J. Monasterio,R. M. Segura,Lluis Armadans,Ana Anglés,Encarna Varela,E. Ruiz,Tomás Fernández de Sevilla +8 more
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TLDR
A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions, which was associated with both enhanced levels of PAIs and decreased levels of t- PA.Abstract:
The response of the fibrinolytic system to inflammatory mediators in empyema and complicated parapneumonic pleural effusions is still uncertain. We prospectively analysed 100 patients with pleural effusion: 25 with empyema or complicated parapneumonic effusion, 22 with tuberculous effusion, 28 with malignant effusion and 25 with transudate effusion. Inflammatory mediators, tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8) and polymorphonuclear elastase, were measured in serum and pleural fluid. Fibrinolytic system parameters, plasminogen, tissue-type plasminogen activator (t-PA) and urokinase PA, PA inhibitor type 1 (PAI 1) and PAI type 2 concentrations and PAI 1 activity, were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test was used to compare plasma and pleural values and to compare pleural values according to the aetiology of the effusion. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid. Significant differences were found between pleural and plasma fibrinolytic system levels. Pleural fluid exudates had higher fibrinolytic levels than transudates. Among exudates, tuberculous, empyema and complicated parapneumonic effusions demonstrated higher pleural PAI levels than malignant effusions, whereas t-PA was lowest in empyema and complicated parapneumonic pleural effusions. PAI concentrations correlated with TNF-α, IL-8 and polymorphonuclear elastase when all exudative effusions were analysed, but the association was not maintained in empyema and complicated parapneumonic effusions. A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions. Blockage of fibrin clearance in empyema and complicated parapneumonic effusions was associated with both enhanced levels of PAIs and decreased levels of t-PA.read more
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Journal ArticleDOI
Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010.
TL;DR: The results of a peer-reviewed systematic literature review combined with expert opinion of the preferred management of pleural infection in adults for clinicians in the UK are presented and clinical guidelines generated are presented.
Journal ArticleDOI
Revisiting the biological roles of PAI2 (SERPINB2) in cancer
TL;DR: It is proposed that the basis of this apparently paradoxical action of two similar serine protease inhibitors lies in key structural differences controlling interactions with components of the extracellular matrix and endocytosis–signalling co-receptors.
Journal ArticleDOI
Parapneumonic pleural effusion and empyema
TL;DR: The use of fibrinolytics remains controversial, although evidence suggests a role for the early use in complicated, loculated parapneumonic effusions and empyema, particularly in poor surgical candidates and in centres with inadequate surgical facilities.
Journal ArticleDOI
Plasminogen Activator Inhibitor Type 1 Gene Polymorphism and Sepsis
TL;DR: In patients with sepsis, the levels of PAI-1 are positively related to poor outcome, increased severity of disease, and increased levels of various cytokines, acute-phase proteins, and coagulation parameters.
Journal ArticleDOI
A double blind randomized cross over trial comparing rate of decortication and efficacy of intrapleural instillation of alteplase vs placebo in patients with empyemas and complicated parapneumonic effusions.
TL;DR: Intrapleural instillation of Alteplase is significantly more effective than Placebo in patients with empyema and PPE, and this study demonstrates it is safe and efficacious with minimal adverse reactions.
References
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Journal ArticleDOI
Pleural Effusions: The Diagnostic Separation of Transudates and Exudates
TL;DR: The utility of pleural-fluid cell counts, protein levels, and lactic dehydrogenase levels for the separation of transudates from e...
Journal ArticleDOI
Adenosine Deaminase in Pleural Fluids: Test for Diagnosis of Tuberculous Pleural Effusion
TL;DR: Assessment of ADA in pathologic fluids is of great value in the diagnosis of tuberculosis of the pleura and in patients with pleural tuberculosis, T-lymphocytes predominate in the fluid but their number did not correlate with ADA-activity.
Journal ArticleDOI
The etiology of pleural effusions in an area with high incidence of tuberculosis.
TL;DR: It is concluded that in the region, the most frequent cause of pleural effusion is tuberculosis, followed by neoplasia and congestive heart failure, andNeoplastic, tuberculous, parapneumonic, empyematous, and other exudative effusions showed no preference for either side.
Journal ArticleDOI
Plasminogen activator and plasminogen activator inhibitor I release during experimental endotoxaemia in chimpanzees: effect of interventions in the cytokine and coagulation cascades.
TL;DR: The fibrinolytic response to a bolus injection of endotoxin in non-human primates was delineated in detail and the contribution of cytokines and thrombin generation to the endotoxin-induced release of tissue-type plasminogen activator and pl asminogen activationator inhibitor 1 was analysed.
Journal ArticleDOI
Immunobiology of pleural inflammation: potential implications for pathogenesis, diagnosis and therapy
Claus Kroegel,Veena B. Antony +1 more
TL;DR: The understanding of these processes and the sequence of events leading to pleural loculation, pleural adhesion or repair are likely to provide the basis for early therapeutic intervention and reduce pleural-associated morbidity.
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