Of the 379 patients who had pleural fluid amylase levels measured, 199 had effusions after cardiac surgery 61, malignant 48, transudative due to congestive heart failure or cirrhosis 28, parapneumonic 2, chylous 2, rheumatoid 1, tuberculous and 1, secondary to chronic pleuritis ( Table 1). We suggest that pleural fluid serum amylase levels be measured only if there is a pretest suspicion of acute pancreatitis, chronic pancreatic disease, or esophageal rupture. Amylase levels greater than 100 U/L (normal serum level in our laboratory is 30-110 U/L) were found in 5 (1.3%) of 379 patients: 1 patient with congestive heart failure (amylase, 173 U/L), 2 with post–cardiac surgery effusions (144 U/L and 130 U/L), 1 with pneumonia (109 U/L), and 1 with lung cancer (105 U/L).Ĭonclusions The routine measurement of pleural fluid amylase levels is neither clinically indicated nor cost-effective. Results Measurement of pleural fluid amylase levels did not assist in determining the origin of the effusion in any of the patients. There were 37 exudates of unknown origin. Of these, 199 had effusions after cardiac surgery 61, malignant 48, transudative 28, parapneumonic 2, chylous 2, rheumatoid 1, tuberculous and 1, from chronic pleuritis. Methods To assess the utility of routine measurement of pleural fluid amylase in evaluating pleural effusions, we measured amylase, glucose, lactate dehydrogenase, and protein levels and blood cell counts in 379 patients undergoing thoracentesis during a 22-month period from 1997 to 1999. Shared Decision Making and Communicationīackground The routine measurement of pleural fluid amylase is frequently recommended, but the cost-effectiveness of this procedure is unknown. Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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