digoxin and Pleural-Effusion

In nonimmune pregnant woman, the primary infection with parvovirus B19 may lead to transplacental transmission to the fetus with variable outcomes, including congenital anemia, hydrops fetalis, fetal death or spontaneous resolution.. The first case was of a 28-year-old woman, gravida 2, para 1, whose fetus was found to have left-sided pleural effusion on a sonogram at 29 weeks of gestation. A sample of aspirated pleural fluid was positive for parvovirus B19 by polymerase chain reaction. Cordocentesis showed fetal hemoglobin level of 5.0 g/dL. Intraperitoneal transfusion (IPT) was performed, because access to the fetal circulation was difficult. Thirty milliliters of group O, Rh-positive packed red cells were transfused into the peritoneal cavity. A non-hydropic baby weighing 2,680 g was delivered at 33 weeks of gestation. The neonates complete blood count examination showed a hemoglobin level of 16.3 g/dL. The newborn baby was discharged in stable condition. The second case was of a 31-year-old woman, gravida 2, para 1, whose fetus was found to have ascites, hypertrophic cardiomyopathy, and placentomegaly on a sonogram at 23 weeks of gestation. An amniotic fluid sample was positive for parvovirus B19 DNA by polymerase chain reaction. Fetal ascites and hypertrophic cardiomyopathy gradually resolved after maternal iron supplementation and 2 weeks of intrauterine digitalization therapy. A healthy infant weighing 3,198 g was delivered at 37 weeks of gestation. The neonates complete blood count examination showed a hemoglobin level of 10.3 g/dL.. Termination of pregnancy is rarely indicated, because B19 virus is not teratogenic. Although intravascular transfusion offers obvious theoretical advantages, in some cases in which access to the fetal circulation is difficult or impossible, IPT should be performed combined with appropriate medical treatment. Thus, there is still a place for IPT in modern management of the severely anemic fetus, and this technique should not be neglected.

Topics: Adult; Amniocentesis; Blood Transfusion, Intrauterine; Cardiotonic Agents; Cordocentesis; Digoxin; Female; Humans; Hydrops Fetalis; Infectious Disease Transmission, Vertical; Parvoviridae Infections; Parvovirus B19, Human; Pleural Effusion; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Second; Premature Birth; Ultrasonography, Prenatal

To establish an method for detecting human telomerase reverse transcriptase (hTERT) mRNA of cells in pleural fluid by in situ hybridization (ISH), and to evaluate preliminarily the efficacy of this new method in recognizing neoplastic cells in the pleural fluid.. Fresh pleural fluid specimens were collected in 23 patients with pleural effusions and cell smears were prepared and after pretreatment, ISH between hTERT mRNA of the cells and digoxin-labelled oligonucleotide probes was performed. The signals of hTERT mRNA were detected by the sequential treatment with antigen, antibody, enzyme, and staining. With strict negative and positive controls, the experimental study was performed independent of clinical diagnosis and treatment.. Positive results were seen in 9 cases of malignant pleural effusions, where dark staining of the cytoplasm and a few stained spots in the cell nuclei could be observed microscopically irrespective of the cytomorphological findings. Seven of the 9 cases had positive results of cytomorphological examination, in which neoplasmic cell with obvious morphological abnormalities were also spotted. In the other 2 cases where cytomorphological findings were negative but pleural biopsy confirmed the diagnosis of malignant pleural effusions, cytoplasm dark staining with stained spots in the cell nuclei were seen under microscope in spite of the absence of obvious abnormality in cell morphology. In contrast, the 14 cases with benign pleural effusions all had negative results, in which neither staining of the cells was identified microscopically, nor was evidently abnormal cell morphology.. As a new method of clinical cytopathology, detection of hTERT mRNA of cells in the pleural fluid by ISH may provide a new means for cytomorphological examination for differential diagnosis between benign and malignant pleural effusions and for classification of the identified tumor cells.

Topics: Digoxin; DNA-Binding Proteins; Humans; In Situ Hybridization; Oligonucleotide Probes; Pleural Effusion; RNA, Messenger; Telomerase

To further define the chemical structure of human endogenous digoxinlike immunoreactive factors (DLIF) we used human pleural effusions as a source of the substance. Digoxinlike immunoreactive factor activity was detected by radioimmunoassay in the pleural fluid of each of four patients; average concentration was 0.35 ng/mL. The chemical profile of DLIF was determined by initial extraction and concentration of DLIF by ion exchange chromatography followed by reverse phase-high-pressure liquid chromatography (RP-HPLC) separation and purification. Using high-pressure liquid chromatography cochromatography of DLIF, together with several radioactively marked glycosides, we observed a single peak of DLIF activity that was chromatographically identical to digoxin. The present study further supports the recent finding that DLIF is related structurally to the cardiac glycosides, and for the first time it has been proven that DLIF is present in pleural fluids.

Topics: Cardenolides; Chromatography, High Pressure Liquid; Chromatography, Ion Exchange; Digoxin; Female; Humans; Lung Neoplasms; Male; Pleural Effusion; Renal Insufficiency; Saponins

In 44 cases with nonimmunologic hydrops fetalis (NIHF), perinatal management was performed based on our protocol. Twenty-one cases were treated by albumin and/or packed red blood cell (PRC) injection into the fetal abdominal cavity, and 8 cases were treated by transplacental digitalization. Among the cases treated by albumin and/or PRC injection, 5 of 7 cases without pleural effusion recovered in utero, and all 5 cases are alive at the time of writing. However, of 14 cases with pleural effusion, none recovered in utero, and only 1 case is alive. Of 8 cases treated by transplacental digitalization, 2 cases recovered in utero, and 1 case is alive. All fetuses with congenital heart anomaly died. This evidence indicates that albumin and/or PRC injection into the fetal abdominal cavity is an effective procedure for in utero treatment of NIHF without pleural effusion, but suggests that in NIHF resulting from either congenital heart anomaly and/or heart failure, the survival rate may not be increased by transplacental digitalization.

Topics: Blood Transfusion, Intrauterine; Digoxin; Erythrocyte Transfusion; Female; Heart Defects, Congenital; Humans; Hydrops Fetalis; Lung; Pleural Effusion; Pregnancy; Pregnancy Outcome; Serum Albumin

Topics: Antibody Formation; Arthritis, Rheumatoid; Digoxin; Echocardiography; Furosemide; Gold; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Pericardium; Plasma Cells; Pleural Effusion; Rheumatoid Factor