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Chronic malignant pleural exudation is generally characterized by little or no fibrin deposition. However, during induced inflammation, fibrin deposition concomitant with cessation of exudation is seen. To judge the involvement of the fibrinolytic system in this process, concentrations of fibrinolytic factors were followed in 10 patients during treatment by quinacrine instillation and tube drainage. Plasminogen and alpha-2-antiplasmin were found in low concentrations and did not show significant changes during treatment. The plasminogen activator inhibitor PAI-1, which plays an important role in the regulation of fibrinolysis, was also studied during treatment. Before treatment the concentration of PAI-1 was 21.7 +/- 12.0 (mean +/- SD) AU/ml and it increased to 86.9 +/- 25.9 AU/ml 6 h after quinacrine instillation. D-dimer, a product of the lysis of fibrin, was found in high concentrations before treatment (62.7 +/- 25.5 micrograms/ml) and in low concentrations 6 h after treatment (12.2 +/- 7.9 micrograms/ml). Thus, it was possible to demonstrate that the fibrinolytic system is activated during chronic malignant pleural exudation and, furthermore, that the activity decreases during induced inflammation.

We sought to determine the incidence rate of carpal tunnel syndrome in the general population. Using three different case definitions, we conducted a prospective study to ascertain by medical record review all cases of incident disease in a defined population during a 2-year period. Newly diagnosed probable or definite carpal tunnel syndrome (N = 309) occurred at a rate of 3.46 cases per 1,000 person-years (95% confidence interval = 3.07-3.84). The incidence rate in our study was 3.5 times higher than the rate 20 years ago in a Minnesota city. The rate difference probably results from a combination of reasons, including a true rise in incidence.

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We studied dietary risk factors for lung cancer among never-smokers in a population-based case-control study in Stockholm, 1989Stockholm, -1995 The results regarding milk products could be consistent with dietary fat as a risk factor for lung cancer, although a more comprehensive assessment of fat intake is necessary to explore this relation. Int.

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In this study, the levels of interleukin-1β (IL-1β) were measured in pleural fluid from patients with chronic malignant pleural effusions, before and during quinacrine-induced pleurodesis. IL-1β levels increased significantly within 24 h after the instillation of quinacrine (p < 0.001). The levels of IL-1β correlated with the amount of pleural fluid production as well as with the tube drainage treatment time. Thus, the more IL-1β levels increased the higher pleural fluid production was seen and a longer drainage treatment time was needed. There were no correlations between IL-1β levels and degree of fever, recruitment of pleural leucocytes, activity of pleural coagulation or inhibition of pleural fibrinolysis.

Recurrent pleural malignant effusion is a common problem which can be treated by inducing symphysis of the pleural sheets. Many different drugs administered into the pleural space can be used to achieve this. The drugs cause an inflammatory response, which in turn is believed to cause the symphysis. Comparatively little has been published on the degree of pleural inflammation and the systemic response and whether this will affect the outcome. The aim of this study was to describe the systemic inflammatory reaction following instillation of a chemical agent into the pleura and to investigate whether this had any predictive value for the outcome (i.e. the pleurodesis). The markers investigated were simple ones: erythrocyte sedimentation rate, C-reactive protein, and leukocyte count from venous blood samples, and the fever reaction. Eighty-nine prospective patients with malignant pleural effusion who underwent pleurodesis with either talc (48 patients) or quinacrine (41 patients) were included in the study. Symphysis was achieved in 82 patients (92 per cent) and all had a prominent transitional elevation of the inflammatory parameters. The unsuccessful attempts caused negligible or very small elevations, but due to the small numbers only the degree of fever after 8 and 48 h showed a statistically significant difference. In conclusion, pleurodesis causes a systemic inflammation and there is a tendency to a correlation between the success of pleurodesis and the degree of inflammation. High fever and high inflammatory parameters including CRP are due to this inflammatory response and do not indicate infection.