Although Meigs’ syndrome is regarded as a well-defined entity, contradictory data on pleural fluid characteristics have been presented, with some papers classifying it as a transudate, whereas others stating that it is an exudate.The aims of the study were: (1) to evaluate pleural fluid characteristics in patients with Meigs’ syndrome and (2) to analyze the prevalence of transudative and exudative pleural effusion in relation to the applied definition of the syndrome.We performed a search through medical databases (MEDLINE, EMBASE, SCOPUS, and GOOGLE SCHOLAR) to identify papers on Meigs’ syndrome published between 1940 and 2013. Two authors independently reviewed each paper searching for prespecified data: (1) signs and symptoms, (2) tumor characteristics, (3) clinical and laboratory data on ascites, (4) clinical, radiological, and laboratory data on pleural fluid, (5) clinical course after tumor removal. All case reports were reclassified according to a new unequivocal classification of Meigs’ syndrome-related entities.A total of 653 papers were initially identified, and 454 articles reporting 541 patients were included in the final analysis. After reclassification according to our case definitions, there were 196, 113, and 108 patients defined as classic Meigs’ syndrome, nonclassic Meigs’ syndrome, and pseudo-Meigs’ syndrome, respectively. Significantly more patients presented with right-sided than left-sided and bilateral pleural effusions (P < 0.001). Median volume of withdrawn pleural fluid was 2950 (1500–6000) mL. The classification of pleural effusion with the use of Light's criteria was possible in only 7 patients. In 6 of these patients pleural effusion met the criteria for an exudate. When the protein concentration > 3.0 g/dL was applied as a criterion of pleural exudate, 88.8% (80/90) of effusions were classified as exudates. Increasing the cut-off level to 3.5 g/dL resulted in only a modest decrease in the percentage of exudative effusions (81%, 73/90).Surprisingly few reports on Meigs’ syndrome present data reliably defining the character of pleural effusion. The available data indicate, however, that the majority of pleural effusions in patients with this entity are exudates. This finding may be a prerequisite for the verification of some earlier presented concepts.

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BACKGROUND: Airway remodeling in asthma and COPD results in bronchial wall thickening. The thickness of the bronchial wall can be measured in high-resolution computed tomography. The objectives of the study were to assess the bronchial lumen and wall dimensions in asthma and COPD patients, in relation to disease severity, and to compare the airway dimensions in patients with asthma and COPD. METHODS: Ten asthma subjects and 12 COPD subjects with stable, mild to moderate disease were investigated. All subjects underwent chest high-resolution computed tomography (window level ؊ 450 Hounsfield units, window width 1,500 Hounsfield units). Cross-sections of bronchi (external diameter 1.0 -5.0 mm) were identified on enlarged images. The following variables were measured: external and internal diameter, wall area, lumen area, total airway area, the percentage of airway wall area, wall thickness, and the ratio of wall thickness to external diameter. Separate sub-analyses were performed for airways with external diameter < 2.0 mm and external diameter > 2.0 mm. RESULTS: We measured 261 and 348 cross-sections of small airways in subjects with asthma and COPD, respectively. There was a significant difference in wall thickness and wall area, which were both greater in asthmatics than in COPD patients. In bronchi with external diameter > 2.0 mm, all measured parameters were significantly higher in asthma than COPD. In individual asthmatics the airway wall thickness was similar in all the assessed bronchi, while in COPD it was related to the external airway diameter. CONCLUSIONS: Our results indicate that bronchial walls are thicker in asthmatics than in patients with COPD. It seems that airway wall thickness and the lumen diameter in patients with asthma are related to disease severity. There is no such a relationship in COPD patients. High-resolution computed tomography may be a useful tool in the assessment of airway structure in obstructive lung disease.

Podstawowym celem tego dokumentu jest opracowanie spójnych wytycznych dotyczących wskazań, przeciwwskazań, metodyki i zasad interpretacji testu 6-minutowego chodu (6MWT, 6 min walk test) w ramach codziennej praktyki szpitalnej i ambulatoryjnej [...]

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Study objectiveTo evaluate the diagnostic value of four different tumor markers: cancer antigen 125 (CA-125), carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1) and neuron specific enolase (NSE) in patients with malignant and non-malignant pleural effusion.Material and methodsOne hundred and two patients with pleural effusion treated in the University Hospital in Warsaw between 2001 and 2003 were studied. They underwent an extensive, diagnostic work-up in order to determine the pleural effusion etiology. Patients with known pleural fluid etiology were labeled as the study group and submitted for further analysis. Pleural fluid and serum samples for CA-125, CEA, CYFRA 21-1 and NSE measurements were collected during the first thoracentesis, centrifuged, and frozen until further use. Pleural fluid and serum concentration of tumor markers were assessed by electrochemiluminescence methods using commercial kits.Results74 patients (32 M, 42 F; mean age 65 ± 14 years) composed the final study group. Exudative pleural effusion was found in 62 patients; of these 36 were malignant (48.6% of all effusions), 20 parapneumonic (or pleural empyema), and 6 tuberculous. In 12 patients, pleural transudate was diagnosed. The highest diagnostic sensitivity for malignant pleural effusion was found for NSE (94.4% and 80.6% in the pleural fluid and serum, respectively). However, the specificity of NSE measurement was relatively low (36.1% and 47.4% in pleural fluid and serum, respectively). The most specific markers of malignant pleural fluid etiology were pleural fluid CYFRA 21-1 and CEA levels (92.1% and 92.1%, respectively). CA-125 was found to be the most specific serum marker of pleural malignancies (78.9%). The AUC for combined pleural markers was 0.89, combined serum markers 0.82, combined ratio pleural/serum markers 0.88.ConclusionsThere are significant differences between the diagnostic value of various pleural fluid and serum markers. Overall, pleural fluid markers are superior to serum markers in determining the pleural fluid etiology. A combination of two or more tumor markers may help improve their diagnostic accuracy. Pleural fluid and serum measurements of different tumor markers play a limited role in the differentiation between malignant and non-malignant pleural effusions.

Contrast-enhanced computed tomography (CECT) and positron emission tomography with 18-FDG (FDG-PET/CT) are used to identify malignant solitary pulmonary nodules. The aim of the study was to evaluate the accuracy of CECT and FDG-PET/CT in diagnosing the etiology of solitary pulmonary nodule (SPN).Eighty patients with newly diagnosed SPN >8 mm were enrolled. The patients were scheduled for either or both, CECT and FDG-PET/CT. The nature of SPN (malignant or benign) was determined either by its pathological examination or radiological criteria.In 71 patients, the etiology of SPN was established and these patients were included in the final analysis. The median SPN diameter in these patients was 13 mm (range 8–30 mm). Twenty-two nodules (31%) were malignant, whereas 49 nodules were benign.FDG-PET/CT was performed in 40 patients, and CECT in 39 subjects. Diagnostic accuracy of CECT was 0.58 (95% confidence interval [CI] 0.41–0.74). The optimal cutoff level discriminating between malignant and benign SPN was an enhancement value of 19 Hounsfield units, for which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CECT were 100%, 37%, 32%, and 100%, respectively. Diagnostic accuracy of FDG-PET/CT reached 0.9 (95% CI 0.76–0.9). The optimal cutoff level for FDG-PET/CT was maximal standardized uptake value (SUV max) 2.1. At this point, the sensitivity, specificity, PPV, and NPV were 77%, 92%, 83%, and 89%, respectively.The diagnostic accuracy of FDG-PET/CT is higher than that of CECT. The advantage of CECT is its high sensitivity and negative predictive value.

The use of EBUS to assess BWT in asthma and COPD is feasible and it shows good compatibility with HRCT. A tendency towards lower BWT values in EBUS when compared to HRCT was observed. The finding that EBUS measurements demonstrated the differences between BWT in patients with obstructive lung diseases and controls, may suggest that EBUS is a more sensitive method to study the BWT than HRCT.