Fm 2005 Completo En' title='Fm 2005 Completo En' />Pleural, peritoneal and pericardial effusions a biochemical approach. Review 1. Medical School University Hospital Sestre Milosrdnice, University Department of Chemistry, Zagreb, Croatia. Medical School University Hospital Sestre Milosrdnice, Department of Transfusiology and Hemostasis, Zagreb, CroatiaCorresponding author laramilevoj at gmail dot com. Abstract. The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented. Key words pleural effusion peritoneal effusion pericardial effusion. Received August 2. Accepted January 1. Introduction. Blood, urine and cerebrospinal fluid are standard samples analyzed in the clinical laboratory. However, occasionally the evaluation of serous extravascular fluids i. Biochemical analysis of such samples can provide the clinician valuable information about the fluids etiology and refer him to final diagnosis and treatment options. Pleural effusions. Pleural effusions result from excessive fluid formation and its accumulation in the pleural space. The most common conditions causing pleural effusions are heart failure, malignancy, pneumonia, tuberculosis and pulmonary embolism. In patients presenting with pleural effusions, efforts should be made to find out the cause so that appropriate treatment can be instituted 1,2. Patient history and physical examination are crucial for the clinical evaluation of pleural effusions. They are followed by confirmation of pleural effusion presence using radiological orand ultrasound studies or computed tomography CT chest scans. Thoracentesis, the removal of pleural fluid using a needle or syringe, is performed either for diagnostic or therapeutic purposes. Fm 2005 Completo LinoEuropa FM es una emisora radiofnica musical espaola, propiedad de Atresmedia Corporacin. Sus estudios centrales estn en Barcelona y cuenta con cobertura. Adobe Cs6 Master Collection Serial Number Crack Keygen. Inter Chievo. InterChievo 50 tripletta di Perisic e Spalletti si prende la vetta. InterChievo 50, tripletta di Perisic. Nerazzurri in testa da soli. Active Fuel Injector Tester Update'>Active Fuel Injector Tester Update. Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. It consists of a polymorphous eruption of macules. Play, Play DX, radio, radioascolto, ricevitori, antenne, onde medie, onde corte, propagazione, bande, frequenze, radiodiffusione, ascolto, hobby, Studio, DX, radio. Classificados. Caminho de Mudana saindo de Lucas do Rio Verde no dia 02 de Dezembro, passando por Tocantins, Par, Maranho e Piau, retornando no dia 14 de. The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on. Objective To determine the attributable mortality caused by delirium in critically ill patients. Design Prospective cohort study. Setting 32 mixed bed intensive care. Star Wars is an American epic space opera media franchise, centered on a film series created by George Lucas. It depicts the adventures of various characters a long. Fm 2005 Completo In English' title='Fm 2005 Completo In English' />It should be coupled with blood sampling within 3. In most cases of pleural effusions, especially if no underlying diagnosis is apparent, biochemical analyses provide important diagnostic information. Various tests can be performed for pleural fluid PF analysis, either as sole or additional diagnostic tools to further determine the effusions etiology 4,5. Appearance of pleural fluid. Although fluid appearance is a nonspecific tool in the evaluation of PF it can provide useful information about the etiology of pleural effusion. Most transudates and many exudates are clear, straw colored, odorless and non viscous fluids 6. A homogeneous bloody appearance, with PF hematocrit of 1 2. A PF hematocrit, exceeding half of the peripheral hematocrit, is indicative of hemothorax. Turbidity of PF can be caused by either the presence of cells and debris or by a high lipid concentration in PF. A clear supernatant, after centrifugation of turbid PFs, indicates that turbidity is caused by cells and debris which might indicate the presence of empyema. Otherwise, if turbidity persists after centrifugation, it is probably due to high lipid concentration, suggesting the presence of chylothorax or pseudochylothorax. Nevertheless, PF triglyceride analysis is a more definitive test and concentrations 1. L indicate that the PF is chyle. An anchovy brown fluid may indicate amebic liver abscess while black fluid suggests Aspergillus infection 4,5,7. Differentiation of exudates from transudates. The initial step in the biochemical evaluation of pleural effusions is to determine whether they are transudative or exudative Figure 1. Transudative pleural effusions are caused by systemic non inflammatory conditions such as heart failure and cirrhosis. They respond to treatment of underlying disease. Exudative effusions are caused by an inflammatory or malignant process affecting the pleura, causing increased capillary permeability and fluid accumulation. Common causes of exudates include pneumonia, cancer, tuberculosis and pulmonary embolism. An extensive diagnostic investigation is required to determine a definite diagnosis 1,5. Figure 1. Biochemical analysis of pleural effusions. LD lactate dehydrogenase URL upper reference limit of serum LD SEAG serum effusion albumin gradient NT pro. BNP N terminal brain natriuretic peptide precursor CHF congestive heart failure IMA ischemia modified albumin ADA adenosine deaminase IFN Interferon CRP C reactive protein. In clinical practice, Lights criteria have been widely accepted to differentiate transudates from exudates for the past 4. Table 1 6,8. In their original study Light et al. In subsequent studies, the original sensitivity of Lights criteria was reproduced, but with lower specificities ranging from 6. Despite this limitation, Lights criteria were reported to be superior to clinical judgment alone in the differentiation of transudates and exudates 1. Table 1. Lights criteria for the differentiation of pleural effusions. Various studies have focused on making Lights criteria more cost effective without affecting its diagnostic accuracy. Better diagnostic performances in comparison to Lights criteria were obtained by quantifying exclusively PF protein and PF lactate dehydrogenase LD 1. An early investigation of PF cholesterol suggested that concentrations 1. L were a cost effective single test that might be used as an alternative to Lights criteria in the differentiation of exudative from transudative effusions 1. However, these results were not corroborated by subsequent studies 1. Additional biochemical parameters and their combinations have been investigated to differentiate the two effusion types. Porcel et al. proposed measurement of cholesterol and LD in PF as an alternative to Lights criteria for the identification of exudates without requiring blood sampling, while Costa et al. PF cholesterol 1. L andor PF LD 2. UL revealed similar diagnostic accuracy to Lights criteria for the differentiation of PFs 1. Recently, concentration of ischemia modified albumin IMA has been found to be increased in transudative pleural effusions compared to tuberculous effusions, and measurement of pleural IMA showed good diagnostic performances although not superior to Lights criteria in transudateexudate differentiation 1. Judas San Pedro Area Serial Killer Wiki. Additional biochemical parameters have also been investigated for this purpose, including alkaline phosphatase ALP, creatine kinase and uric acid. They showed poorer diagnostic performances compared to Lights criteria 1. It has been estimated that up to 2. CHF due to the use of diuretics 2. Diuretic therapy in patients with CHF was reported to cause fluid shifting from the pleural space, thus elevating concentrations of various PF components, including PF protein and PF LD. Consequently, transudative pleural effusions associated with CHF could fulfill exudative diagnostic criteria 4,2.