News about Health (Part 3)

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: IL-8

Pleural Fluid Volume: The pleural fluid volume was significantly greater after the intrapleural injection of SN than it was after the intrapleural injection of TL at each time point (Table 1). The amount of pleural fluid tended to increase with time in both groups.
IL-8: There were detectable levels of IL-8 in the pleural fluid after the intrapleural injection of both TL and SN. The highest level of pleural fluid IL-8 occurred in the SN group 6 h after injection, and this level was significantly higher than the levels occurring at 24 or 48 h after SN injection or at any time after the injection of TL (Table 2). The pleural fluid levels of IL-8 were comparable to those in serum, except for the level 6 h after SN injection, which was significantly higher than the serum level (Table 2).

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: Pleural Fluid

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: Pleural FluidLDH: The intrapleural injection of SN, but not TL or saline solution, led to a short-term increase in serum LDH levels. The mean serum LDH level was significantly higher 6 h after the injection of SN (540 ± 215 IU/L) than after the injection of TL (300 ± 91 IU/L) or saline solution (238 ± 150 IU/L), or compared to the levels in the controls (217 ± 84 IU/L). The increase in the serum LDH level following SN injection had disappeared by 24 and 48 h (Fig 3).

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: Cytokines Analysis

IL-8 (OptEIA, rabbit IL-8 set; Pharmingen; San Diego, CA) and VEGF (R&D Systems; Minneapolis, MN) were measured by enzyme-linked immunosorbent assay according to the manufacturers’ directions. Quantification of IL-8 and VEGF was done by comparison of the optical density in the enzyme-linked immunosorbent assay reader (Power Wave; Bio-Tek; Winooski, VT) using a 450-nm filter with the optical density of controls.

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: Reagents

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: ReagentsThe animals were killed with a lethal injection of pentobarbital (USP Pharmacy). Immediately before the pentobarbital injection, a blood sample from each animal was collected for comparison with normal blood parameters from noninjected rabbits. After death, the animals were exsanguinated by aortic section through a middle abdominal incision, and a 21-gauge needle was inserted through the diaphragm to aspirate the fluid. After the fluid was aspirated, the thoracic cavity was opened and grossly inspected for the presence of TL. Animals injected with saline solution were used as benign noninflammatory controls. Blood samples were collected from a group of six noninjected rabbits as controls on the measurements in the blood of the injected animals. The study was approved by the Ethics Committee of the Heart Institute (InCor), University of Sao Paulo Medical School, which oversees research involving both animals and humans.

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits: Pleural Injection

SN was one of the first agents used for pleurodesis in concentrations varying from 1 to 10% and had a success rate of 75 to 90%. In a rabbit model with normal pleura, the intrapleural injection of 0.5% SN produced a pleurodesis similar to that produced by 35 mg/kg tetracycline and was superior to that induced by TL slurry, 400 mg/kg. Of concern was the possibility that, due to its intense local caustic effect, SN could produce lung damage. However, in a subsequent 1-year follow-up study, SN induced only minimal microscopic lung damage that decreased after 2 weeks, and was similar to that produced by TL after 21 days.

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in Rabbits

Systemic Inflammatory Effects During the Acute Phase of Experimental Pleurodesis in RabbitsPleurodesis is routinely used for the treatment of recurrent malignant pleural effusions. Many agents have been used to produce a pleural symphysis, including silver nitrate (SN), quinacrine, tetracycline and its derivatives doxycycline and minocycline, bleomycin, Corynebacterium parvum, and talc (TL), with different degrees of success. Therapy with SN, which was one of the first agents used to control recurrent pneumothorax, was abandoned apparently because it caused intense pain. The antimalarial agents, particularly quinacrine, are known to induce fever and multiple pleural loculationsA Tetracycline is no longer commercially available and has been replaced mainly by doxycycline, which also causes intense pain. Bleomycin, an antineoplastic agent, was once extensively used, but it is expensive and did not induce pleurodesis in rabbits. C parvum, used mostly in Europe, also was abandoned because its commercial production was stopped.

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Conclusion

Our case patient met each of the Coleman criteria. His rash, lymphadenopathy, and constitutional symptoms of fevers, chills, night sweats, and weight loss were all well-described clinical manifestations of secondary syphilis. Serologic testing, including positive rapid plasma reagin and fluorescent treponemal antibody absorption test results, confirmed the disease. Chest imaging revealed multiple bilateral basilar nodules, and other possible etiologies (including Wegener granulomatosis, lymphoma, and tuberculosis) were excluded. Consistent with secondary syphilis, a Jarisch-Herxheimer reaction developed after the first infusion of penicillin, manifested by hypotension, tachycardia, fever as high as 39.4°C, rigors, myalgias, headache, and nausea. Two months after completing therapy, a follow-up CT scan of the chest revealed near-complete resolution of the pulmonary nodules (Fig 4).

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Patients

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: PatientsAmong the protean clinical manifestations of syphilis, pulmonary involvement is unusual. While nodular (or gummatous) and fibrotic lesions of the lung (usually with pleural involvement) are well established yet uncommon complications of tertiary syph-ilis, pulmonary involvement in secondary syphilis is extremely rare.
Though it may be argued that cases of pulmonary involvement in secondary syphilis potentially are missed because radiography is not routinely performed, evidence points to the contrary. In a study conducted at Bellevue hospital between the years 1939 and 1944, 1,500 patients with secondary syphilis were screened for pathologic findings in the chest prior to arsenic treatment; none of these patients showed radiographic evidence of pulmonary involvement (S. Landry, quoted in Biro et al).

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Diagnosis

Subsequent laboratory evaluation included the following: erythrocyte sedimentation rate, 49 mm/h; HIV by enzyme-linked immunosorbent assay, negative; viral hepatitis panel, negative; urine and blood cultures, no growth; skin biopsy fungal culture, no growth; antinuclear antibody, titer of 1:80 in a speckled pattern; rheumatoid factor, negative; and antineutrophil cytoplasmic antibody panel, negative. A purified protein derivative skin test was placed, and the result was negative.

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary NodulesA50-year-old heterosexual man presented to the emergency department for evaluation of a diffuse rash that started 10 weeks prior to hospital admission. He reported that the lesions began as small (0.3 cm), pink papules on his upper extremities, which progressed into large (3 cm), red, annular, plaque-like lesions that developed a thin scale within several days of onset. Subsequently, the lesions spread to his scalp, face, trunk, genitals, and lower extremities. He reported subjective fevers, chills, occasional drenching night sweats, and a 10-lb weight loss. Simultaneous with the onset of the skin lesions, he had an intermittent nonproductive cough, without dyspnea. Six weeks prior to presentation, he described the onset of sinus congestion with occasional epistaxis and left eye conjunctivitis, at which time he received a course of antibiotics. He denied any significant medical history. He also denied tobacco use, animal exposures, or recent travel. He worked as a cartographer in Colorado.

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