STEVEN A. SAHN, M.D.; JAMES T. GOOD Jr., M.D.
Study Objective: To determine whether the measurement of pleural fluid pH in malignant effusions has diagnostic use, predicts survival, and has therapeutic implications.
Design: A prospective comparison of cytologic examinations and pleural biopsy results, survival, and response to chemical pleurodesis with tetracycline in patients with normal-pH (7.30 or greater) and low-pH (less than 7.30) malignant pleural effusions.
Setting: Academic medical center, university referral hospital, city hospital, and Veterans Administration hospital.
Patients: Sixty patients with malignant pleural effusions, proven at either initial thoracentesis by cytologic examination or within 4 months of initial thoracentesis by repeat thoracentesis, thoracotomy, or autopsy, were followed until death.
Intervention: Twenty-one patients, 12 with normal pleural fluid pH and 9 with low pleural fluid pH, were treated with tube thoracostomy and intrapleural tetracycline for symptomatic, recurrent pleural effusions.
Main Results: The 20 patients with low-pH malignant effusions had a significantly greater positivity on initial pleural fluid cytologic evaluation, a shorter mean survival, and a poorer response to tetracycline pleurodesis compared with 40 patients with normal-pH malignant effusions.
Conclusions: Determination of pleural fluid pH in malignant effusions provides a rational approach to further diagnostic testing, prognostic information, and a rationale for palliative treatment.
SAHN SA, GOOD JT. Pleural Fluid pH in Malignant Effusions: Diagnostic, Prognostic, and Therapeutic Implications. Ann Intern Med. ;108:345–349. doi: 10.7326/0003-4819-108-3-345
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Published: Ann Intern Med. 1988;108(3):345-349.
Cardiology, Pericardial Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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