Objetivo: Evaluar la utilidad del estudios citológicos del líquido pleural en pacientes con derrame pleural maligno en pacientes del Hospital Nacional Hipólito Unanue en el 2014-2015. Métodos: se realizó un estudio descriptivo, observacional, retrospectivo en base a la recopilación de datos registrados en la base de datos de citología de líquido pleural y biopsias pleurales del servicio de anatomía patológica, participaron 245 pacientes del año 2014-2015, de sexo femenino a predominio, considerando importante la medición de la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo para diagnóstico de derrame pleural maligno. Resultados: se encontró en este estudio una sensibilidad de la citología tanto para PAP como Block Cells fue de (37)80.4% y una especificidad de (191)96%, VPP 0.82 y un VPN 0.95 en pacientes con derrame pleural maligno del Hospital Nacional Hipólito Unanue. Conclusión: La citología (Block Cells y PAP) continúa siendo una prueba diagnóstica sencilla, de bajo costo, corta espera y de indudable valor en el diagnóstico del derrame pleural maligno por lo que se recomienda seguir investigando más sobre este tipo de examen.

O estudo descreve a evolução de uma série de 50 pacientes submetidos à pleuroscopia convencional para tratamento de empiema pleural fase fibrinopurulenta, no Serviço de Cirurgia Torácica da Universidade de Caxias do Sul, RS. Através da análise bivariada, foram identificados três fatores prognósticos desfavoráveis ao desfecho - resolução do empiema: mau estado geral dos pacientes, presença de germes anaeróbios no líquido pleural e expansibilidade pulmonar parcial no pós-operatório imediato (p < 0,001). A criação de um índice prognóstico derivado do modelo multivariado, composto pela combinação destes três fatores prognósticos, permitiu a identificação da importância destes fatores na resolução do empiema. Nos pacientes em que nenhum ou apenas um dos três fatores foi identificado (43 pacientes), houve 100% de resolução do empiema. A presença de dois fatores (3 pacientes) determinou a resolução do empiema em 33,3% dos casos. Nos 4 pacientes restantes, em que foram identificados os 3 fatores, nenhum apresentou resolução do empiema através da pleuroscopia. O método permitiu a resolução do empiema em 90% dos casos. O período médio de permanência hospitalar foi de 12,3 dias ± 5,7 para os pacientes com resolução do processo infeccioso e de 21 ,2 ± 5,1 para os casos de insucesso terapêutico. A morbidade e a mortalidade foram de 14% e de 4%, respectivamente. A realização de tomografia computadorizada ou ecografia torácica para identificar corretamente a presença das septações pleurais foi necessária em 23 pacientes (46%), o que os torna critério indispensável à indicação da pleuroscopia no tratamento do empiema pleural fase fibrinopurulenta. / This study describes the evolution of a series of fifty(50) patients that underwent conventional pleuroscopy for lhe treatment of pleural empyema in the fibrinopurulent stage at lhe Thoracic Surgery Unit of the University of Caxias do Sul, RS. A bi-varied analysis identified three unfavorable prognostic factors for the resolution of the empyema : a general bad health condition of lhe patients, the presence of anaerobe germs in the pleural liquid, and partial pulmonary expansibility during the early postoperative period. ( p<0,001) The creation of a prognostic indicator from a multi-varied model, made up by the combination of three prognostic factors, helped to identify the importance of these factors in the resolution of the empyema. In lhe patients where none of the three factors were identified (43 patients) there was 100% resolution of the empyema. The presence of two factors (3 patients) determined the resolution of the empyema in 33,3% of the cases. In the remaining 4 patients the three factors were identified and none of them presented resolution of the empyema by means of a pleuroscopy. The method led to the resolution of empyema in 90% of the cases. The average in-hospital period ranged from 12,3 days ± 5, 7 for patients whit resolution of the infectious process and 21,2 ± 5,1 for the cases of therapeutic failure. Morbidity reached 14% and mortality 4%. Computed tomography and thoracic ecography in arder to accurately identify the presence of pleural sepsis were necessary for 23 patients(46%), wich proves theses procedures are indispensable criteria for the indication of pleuroscopy in the treatment of pleural empyema in the fibrinopurulent stage.

O estudo descreve a evolução de uma série de 50 pacientes submetidos à pleuroscopia convencional para tratamento de empiema pleural fase fibrinopurulenta, no Serviço de Cirurgia Torácica da Universidade de Caxias do Sul, RS. Através da análise bivariada, foram identificados três fatores prognósticos desfavoráveis ao desfecho - resolução do empiema: mau estado geral dos pacientes, presença de germes anaeróbios no líquido pleural e expansibilidade pulmonar parcial no pós-operatório imediato (p < 0,001). A criação de um índice prognóstico derivado do modelo multivariado, composto pela combinação destes três fatores prognósticos, permitiu a identificação da importância destes fatores na resolução do empiema. Nos pacientes em que nenhum ou apenas um dos três fatores foi identificado (43 pacientes), houve 100% de resolução do empiema. A presença de dois fatores (3 pacientes) determinou a resolução do empiema em 33,3% dos casos. Nos 4 pacientes restantes, em que foram identificados os 3 fatores, nenhum apresentou resolução do empiema através da pleuroscopia. O método permitiu a resolução do empiema em 90% dos casos. O período médio de permanência hospitalar foi de 12,3 dias ± 5,7 para os pacientes com resolução do processo infeccioso e de 21 ,2 ± 5,1 para os casos de insucesso terapêutico. A morbidade e a mortalidade foram de 14% e de 4%, respectivamente. A realização de tomografia computadorizada ou ecografia torácica para identificar corretamente a presença das septações pleurais foi necessária em 23 pacientes (46%), o que os torna critério indispensável à indicação da pleuroscopia no tratamento do empiema pleural fase fibrinopurulenta. / This study describes the evolution of a series of fifty(50) patients that underwent conventional pleuroscopy for lhe treatment of pleural empyema in the fibrinopurulent stage at lhe Thoracic Surgery Unit of the University of Caxias do Sul, RS. A bi-varied analysis identified three unfavorable prognostic factors for the resolution of the empyema : a general bad health condition of lhe patients, the presence of anaerobe germs in the pleural liquid, and partial pulmonary expansibility during the early postoperative period. ( p<0,001) The creation of a prognostic indicator from a multi-varied model, made up by the combination of three prognostic factors, helped to identify the importance of these factors in the resolution of the empyema. In lhe patients where none of the three factors were identified (43 patients) there was 100% resolution of the empyema. The presence of two factors (3 patients) determined the resolution of the empyema in 33,3% of the cases. In the remaining 4 patients the three factors were identified and none of them presented resolution of the empyema by means of a pleuroscopy. The method led to the resolution of empyema in 90% of the cases. The average in-hospital period ranged from 12,3 days ± 5, 7 for patients whit resolution of the infectious process and 21,2 ± 5,1 for the cases of therapeutic failure. Morbidity reached 14% and mortality 4%. Computed tomography and thoracic ecography in arder to accurately identify the presence of pleural sepsis were necessary for 23 patients(46%), wich proves theses procedures are indispensable criteria for the indication of pleuroscopy in the treatment of pleural empyema in the fibrinopurulent stage.

O estudo descreve a evolução de uma série de 50 pacientes submetidos à pleuroscopia convencional para tratamento de empiema pleural fase fibrinopurulenta, no Serviço de Cirurgia Torácica da Universidade de Caxias do Sul, RS. Através da análise bivariada, foram identificados três fatores prognósticos desfavoráveis ao desfecho - resolução do empiema: mau estado geral dos pacientes, presença de germes anaeróbios no líquido pleural e expansibilidade pulmonar parcial no pós-operatório imediato (p < 0,001). A criação de um índice prognóstico derivado do modelo multivariado, composto pela combinação destes três fatores prognósticos, permitiu a identificação da importância destes fatores na resolução do empiema. Nos pacientes em que nenhum ou apenas um dos três fatores foi identificado (43 pacientes), houve 100% de resolução do empiema. A presença de dois fatores (3 pacientes) determinou a resolução do empiema em 33,3% dos casos. Nos 4 pacientes restantes, em que foram identificados os 3 fatores, nenhum apresentou resolução do empiema através da pleuroscopia. O método permitiu a resolução do empiema em 90% dos casos. O período médio de permanência hospitalar foi de 12,3 dias ± 5,7 para os pacientes com resolução do processo infeccioso e de 21 ,2 ± 5,1 para os casos de insucesso terapêutico. A morbidade e a mortalidade foram de 14% e de 4%, respectivamente. A realização de tomografia computadorizada ou ecografia torácica para identificar corretamente a presença das septações pleurais foi necessária em 23 pacientes (46%), o que os torna critério indispensável à indicação da pleuroscopia no tratamento do empiema pleural fase fibrinopurulenta. / This study describes the evolution of a series of fifty(50) patients that underwent conventional pleuroscopy for lhe treatment of pleural empyema in the fibrinopurulent stage at lhe Thoracic Surgery Unit of the University of Caxias do Sul, RS. A bi-varied analysis identified three unfavorable prognostic factors for the resolution of the empyema : a general bad health condition of lhe patients, the presence of anaerobe germs in the pleural liquid, and partial pulmonary expansibility during the early postoperative period. ( p<0,001) The creation of a prognostic indicator from a multi-varied model, made up by the combination of three prognostic factors, helped to identify the importance of these factors in the resolution of the empyema. In lhe patients where none of the three factors were identified (43 patients) there was 100% resolution of the empyema. The presence of two factors (3 patients) determined the resolution of the empyema in 33,3% of the cases. In the remaining 4 patients the three factors were identified and none of them presented resolution of the empyema by means of a pleuroscopy. The method led to the resolution of empyema in 90% of the cases. The average in-hospital period ranged from 12,3 days ± 5, 7 for patients whit resolution of the infectious process and 21,2 ± 5,1 for the cases of therapeutic failure. Morbidity reached 14% and mortality 4%. Computed tomography and thoracic ecography in arder to accurately identify the presence of pleural sepsis were necessary for 23 patients(46%), wich proves theses procedures are indispensable criteria for the indication of pleuroscopy in the treatment of pleural empyema in the fibrinopurulent stage.

Des marqueurs pleuraux pouvant discriminer les pleurésies bénignes et malignes sont nécessaires. Parmi les possibles biomarqueurs, les microparticules (MPs) ont été décrites dans les compartiments biologiques humains ; mais peu de données existent sur leur existence dans le liquide pleural. Etant donné que les cellules tumorales produisent un grand nombre de MPs, nous avons fait l’hypothèse de la présence de MPs tumoraux (TMPs) dans les pleurésies et de leur implication dans la carcinogénèse.Donc, pour la première fois nous avons montré de nombreuses MPs pleurales produites par des cellules normales et malignes et nous avons caractérisé leur cellule d’origine.De plus, nous avons montré des TMPs pleurales exprimant l’antigène EpCAM : ce travail donne les bases pour l’utilisation de ce prometteur biomarqueur pour classifier les pleurésies. Nous avons décrit des cas cliniques de patients avec cytologie négative, mais positifs à la présence de MPs pleurales EpCAM+ : donc, les MPs EpCAM+ peuvent être un outil complémentaire à la cytologie, pour améliorer le diagnostic des MPEs. Ce travail ouvre aussi de nouvelles perspectives pour un monitorage mini-invasif et pour une médecine personnalisée avec une cible EpCAM.Etant donné que les TMPs ont de nombreuses activités, il est possible que les MPs EpCAM+ jouent un rôle majeur dans la carcinogenèse au niveau du microenvironnement pleural.Ces résultats donnent les bases pour la détection des TMPs par cytométrie en flux comme possibles biomarqueurs non-invasif pour la classification des épanchements pleuraux. / Pleural biomarkers which could discriminate benign and malignant pleural effusion are needed.Among candidate biomarkers, microparticles (MPs), have been reported in human body fluids, but little is known about their existence in pleural fluid. Because tumor cells produce high numbers of MPs, we hypothesized the presence of tumor-derived MPs (TMP) in pleuresy and their involvement in carcinogenesis.Therefore, for the first time, we report the presence of high amounts of MPs originating from normal and malignant cells in pleural fluids, and we characterizes their cellular origin. Moreover, we showed pleural TMPs expressing the EpCAM antigen from carcinoma patients : this work establishes the basis for using this promising biomarker to distinguish benign and MPE. We showed clinical cases of cancer patients, negative at cytology, but positive for pleural EpCAM+MPs : thus, EpCAM+MPs may be considered as a complementary tool with the cytology to classify pleurisies. This work also opens new directions about mini-invasive monitoring and personalized medicine targeting EpCAM. Since TMPs also carry various features and genetic signatures implicated in malignacy, it can be assumed that EpCAM+MPs could behave as relevant players of carcinogenesis in the pleural microenvironment. Although the sensitivity and specificity of a diagnosis by TMPs should be established in larger multicenter cohorts, this study establishes the basis for the detection of TMPs by flow cytometry as potential biomarkers for the classification of pleural effusions.

Orientador: José Dirceu Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T16:03:58Z (GMT). No. of bitstreams: 1 Vervloet_LeticiaAlves_D.pdf: 6473435 bytes, checksum: 49bac4286557616573190a6494802cbb (MD5) Previous issue date: 2012 / Resumo: Objetivo: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC) e derrames pleurais parapneumônicos (DPP) relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. Métodos: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6) segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 34; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. Resultados: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e maior tempo de evolução, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior tempo de evolução e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. . Conclusões: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%, com evolução mais prolongada e quadro mais leves, que por outros microorganismos. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio / Abstract: Objective: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP) and parapneumonic pleural effusion (PPE) in children and adolescents. Methods: This was a retrospective observational study involving 121 patients with CAP/PPE hospitalized in a tertiary referral hospital between 2000 and 2008, divided into six groups according to the etiologic agent (G1 to G6, respectively): M. pneumoniae with or without co-infection, in 44 patients (group 1); etiologic agents other than M. pneumoniae, in 77 (group 2); M. pneumoniae without co-infection, in 34 (group 3); Streptococcus pneumoniae, in 34 (group 4); Staphylococcus aureus, in 34 (group 5); and M. pneumoniae/S. pneumoniae co-infection, in 9 (group 6). Results: In comparison with group 2, group 1 showed higher frequencies of females, dry cough, and previous use of beta-lactam antibiotics; longer disease evolution; and lower frequencies of use of mechanical ventilation and chest tube drainage. In comparison with groups 4 and 5, group 3 showed higher frequencies of previous use of beta-lactam antibiotics and dry cough; longer disease evolution; a lower frequency of use of chest tube drainage; a higher mean age and a lower frequency of nausea/vomiting (versus group 4 only); and a lower frequency of use of mechanical ventilation (versus group 5 only). M. pneumoniae/S. pneumoniae co-infection increased the duration of symptoms prior to admission. Conclusions: In this sample, the prevalence of M. pneumoniae-related CAP/PPE was 12.75%, with evolution longer and more prolonged course than other microorganisms. Our data suggest that M. pneumoniae-related CAP and PPE in children and adolescents should be more thoroughly investigated in Brazil / Doutorado / Pediatria / Doutor em Saude da Criança e do Adolescente

Abstract Fibrotic pulmonary and pleural disorders represent a group of intrathoracic disorders with different etiologies and prognoses. A prominent part of both pulmonary and pleural fibrotic disorders remains etiologically unknown. An essential feature for all these disorders is an increase and disarray of many extracellular matrix proteins which take part in the remodeling of the fibrotic tissue. Further, the injury in pulmonary as well as in pleural fibrosis occurs often at the border between the epithelial or mesothelial and the mesenchymal cells breaking the epithelial basement membrane. Tenascin is an oligomeric matrix glycoprotein of the extracellular matrix. The best known isoforms are tenascin -C, -X, -R, -Y and -W. Tenascin-C is synthesized during embryonic development, expressed in a variety of tumors, being absent or scantily expressed in most adult tissues. The function of tenascin-C is still unclear. In lung, tenascin-C has been shown to be expressed in fetal lung during branching morphogenesis, benign and malignant lung tumors, idiopathic pulmonary fibrosis, sarcoidosis and asthma. The aim of the present study was to study tenascin-C (later called tenascin) expression in various types of pulmonary fibrosis such as usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), nonspecific interstitial pneumonia (NSIP), bronchiolitis obliterans organizing pneumonia (BOOP), sarcoidosis and extrinsic allergic alveolitis as well as in fibrotic and inflammatory disorders of the pleura of different etiologies. Further, the aims were to compare the accumulation of tenascin with the prognosis in UIP, to confirm the immunohistochemical findings in UIP by Western blotting and immunoelectron miscroscopic (immuno-EM) studies, to investigate which cells synthesize tenascin in UIP and in pleural fibrosis by mRNA in situ hybridization, and to determine whether epithelial lining fluid (ELF) and serum tenascin concentration are increased in patients with UIP, sarcoidosis and extrinsic allergic alveolitis. Tenascin was shown to be increased by immunohistochemical studies in all types of pulmonary and pleural fibrotic disorders included in the study. In UIP, increased tenascin expression was associated with a shortened survival time of the patients. In immuno-EM, labeling for tenascin was seen within type II pneumocytes. UIP cases showed reactivity for a polypeptide of Mr = 200 000 by Western blotting. Myofibroblasts and type II pneumocytes were mainly shown to synthesize tenascin in UIP. Also in pleural fibrosis myofibroblasts, and in addition possibly mesothelial cells, were observed to be responsible for its synthesis. ELF and serum tenascin concentrations were increased in UIP, sarcoidosis and extrinsic allergic alveolitis. In conclusion, tenascin expression is increased in pulmonary and pleural fibrotic disorders, especially in newly formed fibrosis. In UIP, tenascin is actively synthesized at the sites of recent epithelial injury, suggesting that it plays an important role in the fibrogenesis in the lung.

Introdução: O acúmulo de líquido na cavidade pleural afeta a dinâmica do sistema respiratório repercutindo no seu comportamento funcional. Contudo, seus efeitos sobre o sono permanecem indefinidos. Objetivos: Determinar a qualidade do sono e o grau de hipoxemia durante a vigília e sono antes e após a toracocentese de alívio em portadores de derrame pleural. Casuística e Métodos: Dentre os pacientes atendidos no grupo de doenças pleurais do HC-FMUSP foram selecionados, de forma consecutiva pacientes clinicamente estáveis com derrame pleural volumoso unilateral no estudo radiológico do tórax. Todos responderam questionários de sono incluindo Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index e Escala de Dispnéia Modificada de Borg. Os pacientes foram submetidos à polissonografia completa e questionários antes e após a punção esvaziadora. Resultados: Foram estudados 19 pacientes, com idade média de 55 ± 18 anos, sendo 11 do sexo masculino. Na presença de líquido pleural, a qualidade objetiva do sono basal não foi satisfatória (PSQI: 9,1 ± 3,5). Após a retirada de 1.624 ± 796 mL houve diminuição significante do índice de dispnéia (Escala Modificada de Borg: 2,3 ± 2,1 vs 0,8 ± 0,9; p < 0,001). As polissonografias pré e pós-toracocentese não demonstraram mudanças no índice apnéia-hipopnéia e no tempo de sono com saturação periférica de oxigênio inferior a 90 %. Houve, após a toracocentese, melhora significativa (p < 0,05) na eficiência do sono e aumento significativo da latência do sono, diminuição da latência do sono e do sono REM e no percentual de sono de estágio 1. Observou-se tendência no aumento do tempo total de sono, no tempo acordado após o início do sono e no percentual de sono REM. A melhora da qualidade do sono não se correlacionou com o volume de líquido pleural retirado, com mudanças no grau de dispnéia ou da SpO2 durante o sono. Conclusões: Pacientes com derrames pleurais volumosos têm qualidade de sono subjetiva e objetivamente insatisfatórias, que melhoram após o esvaziamento da cavidade pleural. Finalmente, não se observou influência da toracocentese no grau de hipoxemia durante a vigília e durante o sono, assim como não houve correlação entre volume de líquido retirado e a dispnéia avaliada pela escala de Borg modificada / Introduction: Large pleural effusion affects pulmonary physiology. However, the impact of pleural effusion on sleep remains unknown. Objectives: To determine the sleep quality and hypoxemia levels during awakeness and sleep before and after therapeutic thoracentesis in patients with pleural effusion. Methods: Among patients of Pleural Diseases Clinic at the Hospital das Clinicas da FMUSP, were recruited clinically stable consecutive patients with large unilateral pleural effusion documented by chest radiograph. All these patients were evaluated by Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS) before polysomnography. Dyspnea Borg scale and full polysomnography were also performed before and after thoracentesis. Results: We studied 19 patients (11 males), age 55 ± 18 years and body mass index 26 ± 5 kg/m2. The baseline quality of sleep was poor (PSQI = 9.1 ± 3.5). The amount of pleural fluid removed was 1624 ± 796 mL and resulted in a significant decrease in dyspnea according to Borg scale (2.3 ± 2.1 vs 0.8 ± 0.9, p < 0.001). The polysomnography before and after thoracentesis showed no significant changes in apnea hypopnea index and sleep time with oxygen saturation (SpO2) < 90%. Significant improvements (p < 0.05) occurred in sleep efficiency, increase in sleep onset, decrease in rapid eye movement (REM) latency from sleep onset and percentage of stage 1 sleep. There was a trend improvement in total sleep time, wake time during sleep period and percentage of REM sleep. However, the improvement in sleep quality was not associated with volume of pleural fluid withdrawn, changes in dyspnea or SpO2 during sleep. Conclusions: Patients with large pleural effusions have poor subjective and objective sleep quality that improves after thoracentesis. Finally, there was no impact of thoracentesis on hypoxemia levels during sleep and awakeness and no relationship was observed between the amount of fluid withdrawn and dyspnea according to Borg scale

Introdução: O acúmulo de líquido na cavidade pleural afeta a dinâmica do sistema respiratório repercutindo no seu comportamento funcional. Contudo, seus efeitos sobre o sono permanecem indefinidos. Objetivos: Determinar a qualidade do sono e o grau de hipoxemia durante a vigília e sono antes e após a toracocentese de alívio em portadores de derrame pleural. Casuística e Métodos: Dentre os pacientes atendidos no grupo de doenças pleurais do HC-FMUSP foram selecionados, de forma consecutiva pacientes clinicamente estáveis com derrame pleural volumoso unilateral no estudo radiológico do tórax. Todos responderam questionários de sono incluindo Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index e Escala de Dispnéia Modificada de Borg. Os pacientes foram submetidos à polissonografia completa e questionários antes e após a punção esvaziadora. Resultados: Foram estudados 19 pacientes, com idade média de 55 ± 18 anos, sendo 11 do sexo masculino. Na presença de líquido pleural, a qualidade objetiva do sono basal não foi satisfatória (PSQI: 9,1 ± 3,5). Após a retirada de 1.624 ± 796 mL houve diminuição significante do índice de dispnéia (Escala Modificada de Borg: 2,3 ± 2,1 vs 0,8 ± 0,9; p < 0,001). As polissonografias pré e pós-toracocentese não demonstraram mudanças no índice apnéia-hipopnéia e no tempo de sono com saturação periférica de oxigênio inferior a 90 %. Houve, após a toracocentese, melhora significativa (p < 0,05) na eficiência do sono e aumento significativo da latência do sono, diminuição da latência do sono e do sono REM e no percentual de sono de estágio 1. Observou-se tendência no aumento do tempo total de sono, no tempo acordado após o início do sono e no percentual de sono REM. A melhora da qualidade do sono não se correlacionou com o volume de líquido pleural retirado, com mudanças no grau de dispnéia ou da SpO2 durante o sono. Conclusões: Pacientes com derrames pleurais volumosos têm qualidade de sono subjetiva e objetivamente insatisfatórias, que melhoram após o esvaziamento da cavidade pleural. Finalmente, não se observou influência da toracocentese no grau de hipoxemia durante a vigília e durante o sono, assim como não houve correlação entre volume de líquido retirado e a dispnéia avaliada pela escala de Borg modificada / Introduction: Large pleural effusion affects pulmonary physiology. However, the impact of pleural effusion on sleep remains unknown. Objectives: To determine the sleep quality and hypoxemia levels during awakeness and sleep before and after therapeutic thoracentesis in patients with pleural effusion. Methods: Among patients of Pleural Diseases Clinic at the Hospital das Clinicas da FMUSP, were recruited clinically stable consecutive patients with large unilateral pleural effusion documented by chest radiograph. All these patients were evaluated by Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS) before polysomnography. Dyspnea Borg scale and full polysomnography were also performed before and after thoracentesis. Results: We studied 19 patients (11 males), age 55 ± 18 years and body mass index 26 ± 5 kg/m2. The baseline quality of sleep was poor (PSQI = 9.1 ± 3.5). The amount of pleural fluid removed was 1624 ± 796 mL and resulted in a significant decrease in dyspnea according to Borg scale (2.3 ± 2.1 vs 0.8 ± 0.9, p < 0.001). The polysomnography before and after thoracentesis showed no significant changes in apnea hypopnea index and sleep time with oxygen saturation (SpO2) < 90%. Significant improvements (p < 0.05) occurred in sleep efficiency, increase in sleep onset, decrease in rapid eye movement (REM) latency from sleep onset and percentage of stage 1 sleep. There was a trend improvement in total sleep time, wake time during sleep period and percentage of REM sleep. However, the improvement in sleep quality was not associated with volume of pleural fluid withdrawn, changes in dyspnea or SpO2 during sleep. Conclusions: Patients with large pleural effusions have poor subjective and objective sleep quality that improves after thoracentesis. Finally, there was no impact of thoracentesis on hypoxemia levels during sleep and awakeness and no relationship was observed between the amount of fluid withdrawn and dyspnea according to Borg scale

A prospective study was undertaken to assess the diagnostic value of various rapid diagnostic tests for tuberculosis in pleural fluid, and to assess the sensitivity and speed of a radiometric mycobacterial culture system (BACTEC, Johnson Laboratories). Patients presenting to the Department of Medicine at Groote Schuur Hospital with pleural effusions for diagnostic pleural aspiration and biopsy over a 6 month period were entered into the study. Because the incidence of tuberculous effusions was observed to be high in this population (65% of 94 patients), patients from the Department of Radiotherapy with proven malignant disease and the development of new pleural effusions requiring diagnostic or therapeutic aspiration were included in the study in order to increase the number of control patients without tuberculosis. The 111 patients (17 of whom were recruited from the Department of Radiotherapy) were divided into 4 diagnostic categories: tuberculosis - 62 patients, malignant - 28 patients, miscellaneous conditions - 10 patients, and undiagnosed - 11 patients (3 of whom probably had tuberculosis). There were 59 male patients. The racial distribution was 11 whites, 51 of mixed race, and 49 blacks. Exudative pleural effusions were present in 109 patients. Closed pleural biopsies with the Abrams needle were performed on 100 patients using a modified version of the standard technique whereby larger specimens were obtained by stripping pleura off the chest wall. Seven pleural biopsies were reported as inadequate by the pathologist and the diagnostic yield of the procedure was 63%. Tuberculosis was confirmed histologically or by culture in 62 patients. The age distribution of these patients was bimodal, with most cases occuring in the third decade. The presentation was usually acute, with 60% of patients being symptomatic for less than 4 weeks. Granulomata were found on initial pleural biopsy in 52 cases (84%). Pleural biopsy culture was positive in 44 cases (71%). The radiometric culture system tested (12B BACTEC) yielded the same number (14) of positive cultures as conventional mycobacterial culture media in pleural fluid, but was almost twice as fast. Bedside inoculation of pleural fluid into 13A BACTEC bottles more than doubled the yield in the 24 patients tested (11 positive cultures compared with 4 each for conventional and 12B BACTEC media, p=0.046). The rapid diagnostic tests assessed on pleural fluid were adenosine deaminase (ADA), an antigen (BCG) capture enzymelinked immunosorbent assay (ELISA), and a specific DNA probe after amplification with the polymerase chain reaction. ADA was found to have a sensitivity of 0.77 and a specificity of 0.83 in the 109 patients tested, and values were significantly higher in tuberculosis patients compared with the other three diagnostic categories (p< 0.001 ). The ELISA test was performed on 103 patients and showed a sensitivity of only 0.26 and a specificity of 0.72. The DNA probe was performed on 43 patients, and had a sensitivity of 0.93 with a specificity of 0.43. Contamination of samples or latent tuberculous infection may have been responsible for the poor specificity of the DNA probe.