The objective of this study was to evaluate the utility of the determination of adenosine deaminase (ADA) level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in Japan, a country with intermediate incidence of tuberculosis (TB). We retrospectively reviewed the clinical records of 435 patients with pleural effusion and investigated their pleural ADA levels as determined by an auto analyzer. ROC analysis was also performed. The study included patients with MPE (n＝188), TPE (n＝124), benign nontuberculous pleural effusion (n＝94), and pleural effusion of unknown etiology (n＝29). The median ADA level in the TPE group was 70.8U/L, which was significantly higher than that in any other groups (p＜0.05). The area under the curve (AUC) in ROC analysis was 0.895. With a cut-off level for ADA of 36U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.5%, 86.5%, 69.7%, and 93.6%, respectively. As many as 9% of patients with lung cancer and 15% of those with mesothelioma were false-positive with this ADA cutoff setting. Although the ADA activity in pleural fluid can help in the diagnosis of TPE, it should be noted that some cases of lung cancer or mesothelioma show high ADA activity in geographical regions with intermediate incidence of TB, in contrast to high prevalence areas.
"However, elevated ADA in ascites has rarely been reported in the diagnosis of lymphoma . False negative and false positive ADA values are possible, and therefore an elevated ADA in ascites should be interpreted in relation to the overall clinical presentation and should not be considered equivalent to the presence of mycobacteria [52, 54]. "
[Show abstract][Hide abstract] ABSTRACT: The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5-20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.
[Show abstract][Hide abstract] ABSTRACT: The critical spare parts (CSP) are vital to machine operation, which also have the characteristic of more expensive, larger demand variation, longer purchasing lead time than non-critical spare parts. Therefore, it is an urgent issue to devise a way to forecast the future required amount of CSP accurately.This investigation proposed moving back-propagation neural network (MBPN) and moving fuzzy neuron network (MFNN) to effectively predict the CSP requirement so as to provide as a reference of spare parts control. This investigation also compare prediction accuracy with other forecasting methods, such like grey prediction method, back-propagation neural network (BPN), fuzzy neuron network (FNN), etc. All of the prediction methods evaluated the real data, which are provided by famous wafer testing factories in Taiwan, the effectiveness of the proposed methods is demonstrated through a real case study.
Expert Systems with Applications 06/2010; 37(6):4358-4367. DOI:10.1016/j.eswa.2009.11.092 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 28-year-old rheumatoid arthritis woman treated with adalimumab was admitted with fever, cough, and right chest pain. X-ray showed right pleural effusion. By medical thoracoscopy, diffuse white nodules were observed, and biopsy specimen demonstrated epithelioid cell granulomas with necrosis and auramine-stained organisms, which suggested a diagnosis of tuberculous pleurisy. Medical thoracoscopy can be a potent diagnostic method when tuberculous pleurisy is suspected. Notably, despite latent tuberculosis treatment, active tuberculosis was not prevented.
Modern Rheumatology 08/2012; 23(5). DOI:10.1007/s10165-012-0727-5 · 2.40 Impact Factor
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