Finally, the measurement of hyperreactivity has been used as a research tool to evaluate the mechanisms underlying the airway responses in occupational asthma. The role of the late asthmatic reaction rather than the immediate reaction in altering bronchial hyperreactivity has been well established. More recently this change in airway reactivity has been shown to follow…
It has been recognized for many years that patients with asthma have increased levels of bronchial responsiveness to pharmacologic, physical, and chemical stimuli. The level of responsiveness correlates reasonably with the severity of asthma. The association between bronchial hyperresponsiveness and bronchial asthma is not absolute. Occupational asthma may occur in the absence of hyperresponsiveness. In…
Nevertheless, caution must be observed, given the two cases with malignant cells whose albumin gradient was in the transudative range. Light et al reported one case with malignant cells in the pleural fluid who also had signs and symptoms of congestive heart failure. The criteria of Light et al classified the effusion as a transudate….
It is not clear why the albumin gradient would be more reliable than Lights criteria. Possibly the total fluid protein level is relatively increased after diuresis, due to a greater percentage of nonalbumin protein that originates in the pleural space. Alternatively, the mathematics of a gradient may be more representative of the protein diffusion than…
Congestive heart failure probably results in pleural eflusions because of increased leakage of fluid into the pulmonary interstitium, which collects in the pleural space, and increased systemic venous pressure, which decreases lymphatic flow and therefore decreases pleural fluid absorption. Diuretics could lead to fluid resolution through multiple mechanisms. By decreasing left atrial pressure, less fluid…
Despite being studied for over 100 years, the physiology of pleural fluid formation and absorption is still controversial. The most recent accepted model of pleural fluid exchange in the normal state involves formation by filtration through the pleural microvas-cular endothelium and absorption via stomata in the parietal pleura that drain into subpleural lymphatic vessels. The…
Although the protocol called for a simultaneous sample of serum to be drawn at the time of thoracentesis, this was not always done by the house staff. Serum samples were accepted within 24 hours of the thoracentesis. In the five patients with a discrepancy between Lights criteria and the albumin gradient, a true simultaneous sample…
The pleural-fluid-to-serum-albumin ratio was also evaluated, but there was more overlap between exudates and transudates (data not shown). Lights criteria correctly identified all 41 patients with exudates; however, five patients with a transudative cause for their pleural effusion were misclassified as exudates using Light’s criteria. One patient had a high protein ratio (0.52), two patients…
Sixty-one patients with pleural effusions were evaluated. One patient was excluded due to the diagnosis of empyema. Another patient was excluded because a simultaneous serum sample was not obtained. Of the 59 remaining patients, 37 were men, and 22 were women. The average age was 61 years (range, 19 to 84 years). Forty-one were defined…
The nephrotic syndrome was diagno-»ed when the patient had proteinuria, edema, and hypoalbuminemia. Malignant effusions were confirmed by cytology, pleural biopsy, or autopsy. A diagnosis of pulmonary emlx)lus or infarction was made when there was a strong clinical suspicion and a high-probabilitv ventilation-perfusion scan or positive angiogram. Parapneumonic effusions were diagnosed when there was an…
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