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Tumor necrosis factor (TNF)-a plays a key role in the inflammatory response. A unique study by Odeh et al showed that pleural fluid levels of this cytokine were significantly higher in CPPE than in UPPE, suggesting a potential role of TNF-a to discriminate between these two types of PPE. In the present investigation, we aimed to clarify this potential clinical interest in analyzing TNF-a in pleural fluid for the identification of nonpurulent CPPE.
Materials and Methods

All consecutive patients with a diagnosis of PPE who were admitted to the Department of Internal Medicine at the University Hospital Arnau de Vilanova (Lleida, Spain) from 1996 to 2002 entered the study. Typical or UPPE described those effusions that were successfully resolved with antibiotics alone. CPPE referred to those nonpurulent-appearing effusions that did not resolve without chest tube drainage, whereas empyema described frank pus within the pleural space, the end stage of a complicated effusion. The final decision concerning pleural space drainage was at the discretion of the attending physician.
The samples obtained by thoracentesis were immediately analyzed for total cell counts, differential cell count, pH, glucose, protein, LDH, adenosine deaminase (ADA), cytology, and both aerobic and anaerobic bacterial cultures.
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