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Introduction One and a half million pleural effusions are diagnosed annually in United States alone [1]. Over recent years, technical advances in the management of pleural effusions have reduced the [...], Background Pleural fluid is typically drawn directly from the pleural space for diagnostic studies, but occasionally analyses are desired when a chest tube is already in place and a traditional approach is not feasible. The diagnostic value of analyzing fluid samples obtained from the pleural fluid collection system after chest tube insertion is unknown. Methods We performed a prospective observational study of patients in whom chest tube placement was planned for clinical indications. Diagnostic studies were performed on fluid obtained from the pleural space at the time of tube insertion and then repeated 2, 6, and 24 h later on samples obtained from the fluid collection system. Results Fifty-five percent of the 23 effusions studied met light's criteria for exudate at baseline. Lactate dehydrogenase (LDH) varied considerably over time from baseline measures with only 25% of measures at 24 h falling within 25% of baseline levels. The sensitivity for exudate by LDH remained 100% with poor specificity ranging 50-69% with repeat measures. Total protein exhibited less variability with 85% of measures at 24 h falling within 25% of baseline measure. Sensitivity and specificity at 24 h were 88 and 82%, respectively. Repeat measures of cholesterol, albumin, and triglycerides generally correlated well (Spearman's rho > 0.90) with baseline values. Measures of glucose and cell counts varied considerably from baseline. Conclusions Analysis of pleural fluid from a chest tube collection system is feasible and can provide useful diagnostic information. Practitioners should consider the test characteristics of each measure when interpreting samples obtained. Keywords Diagnostic techniques * Respiratory system * Routine * Diagnostic techniques and procedures * Pleural disease * Pleural effusion

Author(s): Robert M. Reed[sup.1] , Anthony Amoroso[sup.2] , Salman Hashmi[sup.1] , Seth Kligerman[sup.3] , Alan R. Shuldiner[sup.4] [sup.5] [sup.6] , Braxton D. Mitchell[sup.4] [sup.5] [sup.6] , Giora Netzer[sup.1] [sup.6] Author [...], Purpose The acute host response to histoplasma capsulatum infection varies according to exposure and susceptibility. Late sequelae include calcifications in the lung, thoracic lymphatics, and spleen. Determinants of calcified granuloma formation are poorly studied and may differ from those affecting acute response. We examined the occupational associations and familial aggregation of radiographic calcified granulomatous disease to characterize the determinants of calcified granuloma formation. Methods We analyzed prospectively collected cross-sectional data including computed tomograms from 872 adult members of the Old Order Amish of Lancaster County. Results Granulomas were present in 71 % of participants. Granulomas were present in the lung of 57 % of participants, in the hilar or mediastinal lymph nodes of 55 % of participants, and in the spleen of 29 % of participants. No significant differences were observed in the presence of granulomas between men and women. Each year of age was associated with 4 % higher odds of splenic calcifications, and a primary occupation of farming was associated with an 84 % higher odds of splenic calcifications. A compelling pattern of familial aggregation was not observed. Conclusions Calcified granulomatous disease does not appear to aggregate in families. Determinants influencing patterns of granulomatous disease include occupation, age, and geographic location.