MCP-1 produced by tumor cells is an important determinant of their capacity to induce the formation of MPE and may be a useful target for the treatment of malignant pleural disease.

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BackgroundDifferential diagnosis of patients with lung infiltrates remains a challenge. Triggering receptor expressed on myeloid cells (TREM)-1 is a neutrophil and monocyte receptor up-regulated during infection. The aim of this study was to evaluate the diagnostic accuracy of TREM-1 and of C-reactive protein (CRP) from patients with lung infiltrates to discern community acquired lung infections.Methods68 patients admitted to a medical ward with acute respiratory illness were enrolled in the study. Neutrophil and monocyte TREM-1 expression were measured by flow cytometry, sTREM-1 by an enzyme immunoassay and C-reactive protein by nephelometry. Clinical pulmonary infection score was recorded.Results34 patients were diagnosed with bacterial community acquired pneumonia (group A) and 34 with non-bacterial pulmonary disease (group B). Median serum TREM-1 concentration was 102.09 pg/ml in group A and lower than 15.10 pg/ml (p < 0.0001) in group B. Mean±SE neutrophil TREM-1 expression was 4.67 ± 0.53 MFI in group A and 2.64 ± 0.25 MFI (p = 0.001) in group B. Monocyte TREM-1 expression was 4.2 ± 0.42 MFI in group A and 2.64 ± 0.35 MFI (p = 0.007) in group B and mean±SE CRP was 18.03 ± 2 mg/ml in group A and 7.1 ± 1.54 mg/ml (p < 0.001) in group B. A cut-off of 19.53 pg/ml of sTREM-1 with sensitivity 82.6% and specificity 63% to discriminate between infectious and non-infectious pulmonary infiltrates was found. sTREM-1 at admission greater than 180 pg/ml was accompanied with unfavourable outcome.ConclusionTREM-1 myeloid expression and sTREM-1 are reliable markers of bacterial infection among patients with pulmonary infiltrates; sTREM-1 is a predictor of final outcome.

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The local application of silver nitrate through a flexible bronchoscopic brush produced a burn and healing process on the mucosa of small bronchopleural fistulae of the central airways, leading to effective and lasting treatment in most cases.

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Background and objective: Medical thoracoscopy (MT) is useful for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates proved to be useful during bronchoscopy. We aimed to evaluate the diagnostic performance of ROSE of MT biopsy specimens and thoracoscopists' impression of the macroscopic appearance and assess the intermodality agreement between ROSE and final histopathologic diagnosis. Methods: Sixty two patients with exudative pleural effusions further investigated with MT were enrolled. MT was performed under local anaesthesia and conscious sedation, using the rigid pleuroscope. ROSE with the Hemacolor rapid staining method of the biopsy specimens was performed. Thoracoscopists' impression of the macroscopic appearance was recorded. The final diagnosis was established following histopathological examination. Results: Thoracoscopic pleural biopsies were diagnosed in 61 patients (98.4%). Group A (n = 25) consisted of patients with malignancy and group B (n = 37) with benign disorders. Area under the curve of ROSE for the diagnosis of malignancy was 0.86 (95% CI: 0.76-0.96, P < 0.001), with a sensitivity of 79.17%, specificity of 94.59%, diagnostic accuracy of 88.5%, positive predictive value of 90.5% and negative predictive value of 87.5%. Intermodality agreement between ROSE and histopathology was good (κ ± SE = 0.615 ± 0.084, P < 0.001). Area under the curve of the thoracoscopists' impression of macroscopic appearance was 0.72 (95% CI: 0.58-0.85, P = 0.001), with a sensitivity of 100%, specificity of 44.7%, positive predictive value of 53.33% and negative predictive value of 100%. Conclusion: Rapid on-site evaluation during MT was found to have high accuracy for predicting malignancy. ROSE can provide the thoracoscopist with an on-site

We present a case of a 58 years old man with a large heterogeneous and well circumscribed soft tissue mass arising from the right pleural surface, found at a computer tomography of his chest. This mass after complete resection through a right lateral open thoracotomy, proved to be a Solitary Fibrous Tumor, previously known as ‘benign mesothelioma’. This tumor is usually discovered at routine chest X-rays since patients are either asymptomatic or report atypical symptoms. Only 10–20% of the published cases report a malignant solitary fibrous tumor, however, definite diagnosis can only be made after complete resection which is the proposed diagnostic algorithm for these cases.