Protein pleural

The pleural tissue is a typical connective tissue that consists mostly of matrix the fibrous proteins (collagen, elastin), and mucopolysaccharides, and a few scattered mesothelial cells, capillaries, venules, and ducts. Anatomists have defined several layers (Fig. 3.4) for each of the pleura. Layers 3 and 5 in Fig. 3.4 contain an abundance of fibrous protein, especially elastin. Both the interstitial (Layer 4) and mesothelial (1 and 2) layers contain capillaries of the vascular system and lymphatic channels. The matrix (ground substance) gives the pleura structural integrity and is responsible for its mechanical properties such as elasticity and distensibility. 

In the normal individual a high protein intake probably does not cause increases in blood urea nitrogen (BUN). However, in the individual with even minimal renal or liver dysfunction, major increases can be observed. In a dehydrated patient with septicemia and pleural abscess after mitral valve surgery, a high-protein diet produced an increase in BUN from normal limits to 100 mg/100 ml (Dll). The serum creatinine only rose to 2.9 mg/100 ml (Dll). Hemorrhage will also create elevations in BUN. In a patient who experienced gastric hemorrhage and hypotension, the BUN rose to 135 mg/100 ml while the creatinine rose only to 2.5 mg/100 ml (Dll). 

Isoniazid does not bind to serum proteins it diffuses readily into all body fluids and cells, including the caseous tuberculous lesions. The drug is detectable in significant quantities in pleural and ascitic fluids, as well as in saliva and skin. The concentrations in the central nervous system (CNS) and cerebrospinal fluid are generally about 20% of plasma levels but may reach close to 100% in the presence of meningeal inflammation. 

Janssen YMW, Driscoll KE, Howard B, et al. 1997. Asbestos causes translocation of p65 protein and increase NF-KB DNA binding activity in rat lung epithelial and pleural mesothelial cells. Am J Pathol 151 389-401. 

Hepatic hydrothorax (C.S. Morrow et al., 1958) is evident during the course of liver cirrhosis with ascites in 0.4-12% of cases. The mean frequency is about 6%, although in two-thirds of the cases, a right-sided effusion (with the author s own patients a bilateral effusion) was ascertained. (66) (s. fig. 16.8) Hepatic hydrothorax is a transudate cell count protein concentration <2.5 g/dl, total protein effusion to serum ratio <0.5, LDH effusion to serum ratio <2.3, serum to pleural fluid albumin gradient >1.1 g/dl. (s. also fig. 16.9) (17, 37, 47, 52 - 54, 66)... 

In cases of long-standing ascites, the protein content can drop due to reduced permeability of the sinusoids to protein or as a result of presinusoidal obstruction. However, because of its aetiology or as a result of diuretic therapy, the protein content may also increase. In 15-20% of cirrhotic patients with ascites, protein values of up to 4.3 g/dl are found. Even with a threshold ranging between 2.5 and 3.0 gidl, the transudatelexudate concept does not work as well with ascites as it does with pleural effusion The inconclusive information obtained from the ascites protein value in individual cases becomes more reliable if the cell count is determined at the same time. (39, 55, 63, 79)... 

A wide range of aldesleukin-induced adverse effects is associated with the capillary leak syndrome, which is characterized by an increase in vascular permeability with subsequent leakage of fluids and proteins into the extravascular space (4). This results in a third-space clinical syndrome, generalized or peripheral edema, weight gain, cardiovascular and pulmonary comphcations with hypotension, pericardial, and pleural effusions, ascites, oliguria, and prerenal azotemia. Symptoms usually resolve in a few days after aldesleukin withdrawal. Studies on the mechanism have raised a number of hypotheses, such as damage to the endothehal cells, release of secondary cytokines, and activation of the complement cascade (15). 

The pleural, pericardial, and peritoneal cavities normally contain a small amount of serous fluid that lubricates the opposing parietal and visceral membrane surfaces. Inflammation or infections affecting the cavities cause fluid to accumulate. The fluid may be removed to determine if it is an effusion or an exudate, a distinction made possible by protein or enzyme analysis. The collection procedure is called paracentesis. When specifically apphed to the pleural cavity, the procedure is a thoracentesis if applied to the pericardial cavity, a pericardiocentesis. Paracenteses shordd be performed only by sldlled and experienced physicians. Pericardiocentesis has now been largely supplanted by echocardiography. 

The proteins most amenable to routine laboratory evaluation die those in blood, urine, CSF amniotic fluid, saliva, feces, and peritoneal or pleural fluids. With few exceptions, the proteins found in all of these are derived from blood plasma. The following discussion is limited to (1) the most abundant plasma proteins, (2) changes of their concentrations in the most accessible body fluids, and (3) a few of the analytical techniques used to measure them. 

Proteins in Amniotic Fluid, Saliva, Feces, and Peritoneal and Pleural Cavities... 

Other disease-related covariates would include ascites and pleural effusion. These comorbid conditions would be expected to increase the volume of distribution of proteins, thus lowering the measured concentrations in the serum. In one case (59), ascites was found to be a weak covariate of clearance as well. 

Di Loreto C, Puglisi F, Di Lauro V, et al. TTF-1 protein expression in pleural malignant mesotheliomas and adenocarcinomas of the lung. Cancer Lett. 1998 124 73-78. 

Moore BH, Gagle PT, Allen TC, et al. Topoisomerasae Il-alpha, minichromosome maintenance protein 2 (MCM2), and X-linked mammalian inhibitor of apoptosis protein (XIAP) expression in pleural diffuse malignant mesothelioma (PDMM) Possible role for chemotherapeutic intervention. Mod Pathol. 2008 21 347A. 

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