Pleural Fluid Analysis: The Test #pleural, #pleural #fluid, #pleural #fluid #analysis, #pleurae, #pleuritis, #pleurisy, #pleural


#

Pleural Fluid Analysis

The Test

How is it used?

Pleural fluid analysis is used to help diagnose the cause of accumulation of fluid in the chest cavity (pleural effusion ). There are two main reasons for fluid accumulation and an initial set of tests, including fluid protein, albumin, or LD level, cell count, and appearance, is used to differentiate between the two types of fluid that may be produced, transudate or exudate .

  • Transudate: an imbalance between the pressure within blood vessels (which drives fluid out of the blood vessel) and the amount of protein in blood (which keeps fluid in the blood vessel) can result in accumulation of fluid. Transudates are most frequently caused by congestive heart failure or cirrhosis. If the fluid is determined to be a transudate, then usually no more tests on the fluid are necessary.
  • Exudate: injury or inflammation of the pleurae may cause abnormal collection of fluid. If the fluid is an exudate, then additional testing is often ordered. Exudates are associated with a variety of conditions and diseases, including:
    • Infectious diseases – caused by viruses. bacteria. or fungi. Infections may originate in the pleurae or spread there from other places in the body. For example, pleuritis and pleural effusion may occur along with or following pneumonia .
    • Bleeding – bleeding disorders. pulmonary embolism. or trauma can lead to blood in the pleural fluid.
    • Inflammatory conditions – such as lung diseases. chronic lung inflammation for example due to prolonged exposure to large amounts of asbestos (asbestosis), sarcoidosis. or autoimmune disorders such as rheumatoid arthritis and lupus
    • Malignancies – such as lymphoma. leukemias. lung cancer. metastatic cancers
    • Other conditions – idiopathic. cardiac bypass surgery, heart or lung transplantation, pancreatitis. or intra-abdominal abscesses

Additional testing on exudate fluid may include:

  • Pleural fluid glucose, lactate, amylase, triglyceride, and/or tumor markers
  • Microscopic examination – a laboratory professional may place a sample of the fluid on a slide and examine it under a microscope. Normal pleural fluid has small numbers of white blood cells (WBCs) but no red blood cells (RBCs) or microorganisms .
  • Cytology – a laboratory professional may use a special centrifuge (cytocentrifuge) to concentrate the fluid’s cells on a slide. The slide is treated with a special stain and evaluated for abnormal cells, such as malignant cells (cancer cells).
  • Gram stain – for direct observation of bacteria or fungi under a microscope. There should be no organisms present in pleural fluid.
  • Bacterial culture and susceptibility testing – ordered to detect any bacteria that may be present in the pleural fluid and to guide antimicrobial therapy.
  • Fungal tests – may include fungal culture and susceptibility testing
  • Adenosine deaminase – may help detect tuberculosis (TB)
  • Less commonly, tests for infectious diseases, such as tests for viruses, mycobacteria (AFB testing ), and parasites .

When is it ordered?

Pleural fluid analysis may be ordered when a healthcare practitioner suspects that a person has a condition or disease that is causing pleuritis and/or pleural effusion. It may be ordered when someone has some combination of the following signs and symptoms :

  • Chest pain that worsens with deep breathing
  • Coughing
  • Difficulty breathing, shortness of breath
  • Fever, chills
  • Fatigue

What does the test result mean?

Test results can help distinguish between types of pleural fluid and help diagnose the cause of fluid accumulation. The initial set of tests performed on a sample of pleural fluid helps determine whether the fluid is a transudate or exudate :

Transudates are most often caused by either congestive heart failure or cirrhosis. Typical fluid analysis results include:

  • Physical characteristics—fluid appears clear
  • Protein, albumin, or LDH level—low
  • Cell count—few cells are present

Exudates can be caused by a variety of conditions and diseases. Initial test results may include:

  • Physical characteristics—fluid may appear cloudy
  • Protein, albumin, or LD level—high
  • Cell count—increased

Additional test results and their associated causes may include:

Physical characteristics – the normal appearance of a sample of pleural fluid is usually light yellow and clear. Abnormal results may give clues to the conditions or diseases present and may include:

  • Reddish pleural fluid may indicate the presence of blood.
  • Cloudy, thick pleural fluid may indicate an infection and/or the presence of white blood cells. It may also indicate leakage of fluid from the lymphatic system (lymph). Lymph drains from the lymphatic system into the venous system in the chest and either trauma or lymphoma can cause lymph to be present in pleural fluid.

Chemical tests – tests that may be performed in addition to protein or albumin may include:

  • Glucose—typically about the same as blood glucose levels; may be lower with infection and rheumatoid arthritis .
  • Lactate levels can increase with infections.
  • Amylase levels may increase with pancreatitis. esophageal rupture, or malignancy.
  • Triglyceride levels may be increased when there is leakage from the lymphatic system.
  • Tumor markers. such as CEA. may be increased with some cancers.

Microscopic examination – Normal pleural fluid has small numbers of white blood cells (WBCs) but no red blood cells (RBCs) or microorganisms. Results of an evaluation of the different kinds of cells present may include:

  • Total cell counts—the WBCs and RBCs in the sample are counted. Increased WBCs may be seen with infections and other causes of pleuritis. Increased RBCs may suggest trauma, malignancy, or pulmonary infarction.
  • WBC differential—determination of percentages of different types of WBCs. An increased number of neutrophils may be seen with bacterial infections. An increased number of lymphocytes may be seen with cancers and tuberculosis .
  • Cytology—a cytocentrifuged sample is treated with a special stain and examined under a microscope for abnormal cells. This is often done when a mesothelioma or metastatic cancer is suspected. The presence of certain abnormal cells, such as tumor cells or immature blood cells, can indicate what type of cancer is involved.

Infectious disease tests – these tests may be performed to look for microorganisms if infection is suspected:

  • Gram stain — for direct observation of bacteria or fungi under a microscope. There should be no organisms present in pleural fluid.
  • Bacterial culture and susceptibility testing —If bacteria are present, susceptibility testing can be performed to guide antimicrobial therapy. If there are no bacteria present, it does not rule out an infection; they may be present in small numbers or their growth may be inhibited because of prior antibiotic therapy.
  • Fungal tests —if a culture is positive, the fungus or fungi causing the infection will be identified in the report and susceptibility testing may be done to guide therapy.
  • Adenosine deaminase—a markedly elevated level in pleural fluid in a person with symptoms that suggest tuberculosis means it is likely that the person tested has a Mycobacterium tuberculosis infection in their pleurae. This is especially true when there is a high prevalence of tuberculosis in the geographic region where a person lives. (For more details, see the test article on Adenosine Deaminase .)

Other less common tests for infectious diseases may be performed and may identify a virus. mycobacteria (such as the mycobacterium that causes tuberculosis), or a parasite as the cause of an infection and fluid accumulation.

Is there anything else I should know?

A blood glucose. protein. albumin. or LD may be ordered to compare concentrations with those in the pleural fluid.


British Retailers Asos, Boden and TopShop Tap U #online #shoping


#british retailers

#

British Retailers Asos, Boden and TopShop Tap U.S. Market For Growth

LONDON, United Kingdom — On the heels of Downton Abbey’s success on American television, British retailers are banking on a love of all things English to expand their business in the world’s biggest apparel market.

Leading the British invasion are online specialist Asos Plc, fashion chain TopShop, catalogue retailer Boden, youth-focused Jack Wills Ltd. and SuperGroup Plc’s Superdry stores. Their strategies vary some trade on British cool, others emphasise local knowhow yet all focus on what they do best rather than buying an existing imprint or starting an entirely new brand that Americans have never heard of.

In doing so, the retailers are learning from the mistakes of fellow British chains such as J Sainsbury Plc and Marks Spencer Group Plc who have retreated from North America. As boutique U.K. firms grab more of the $200 billion U.S. market, that poses a threat to American mainstays like Gap Inc., J. Crew Group Inc. and Abercrombie Fitch, who have been busy expanding outside their home country.

“U.K. retailers that are succeeding have a very strong, differentiated brand positioning that is well understood by the American consumer,” said Ian Geddes, U.K. head of retail at consultants Deloitte LLP. “They are doing well by emphasising what their brand stands for.”

British retailers have for decades gazed longingly across the Atlantic, and the desire to broaden their operations is stronger today amid an anemic U.K. retail industry.

Yet these forays often end badly. In 1988, Marks Spencer, Britain’s largest clothing retailer, paid $750 million for Brooks Brothers, the oldest U.S. clothier, only to sell it for less than a third of the purchase price 13 years later amid a shift away from suits to more casual duds like Gap’s khakis. Tesco Plc sunk 1 billion pounds ($1.5 billion) into its Fresh Easy U.S. grocery chain over the past five years without making a profit, and has said it will likely leave the U.S. after a review of the business.

Today, British retailers are winning fans by just being themselves. The online-only fashion retailer Asos, whose own- brand sequin sunset dress was spotted on singer Katy Perry, has lured American consumers since its 2010 debut with free delivery and returns of items ranging from $542 Edun Mesh designer jumpsuits to $11.87 own-label crop tops. It stays on top of consumer trends with an 11-strong team based in New York that makes decisions locally.

“There will be more people we put into the U.S. team so I expect them to find their footing and accelerate growth,” Finance Director Nicholas Beighton told analysts in March. “There is a bigger market in the U.S. there are more options, more channels, more digital marketing channels.”

U.S. sales increased 54 percent to 35.6 million pounds in the six months ended Feb. 28, making America Asos’s fastest- growing market. With more than one million registered customers as of December, the U.S. is now its largest market outside the U.K. with nine percent of revenue. The shares have soared 88 percent over the past year, well ahead of the FTSE All-Share Index’s 12 percent gain.

Another winner is TopShop, the flagship chain of billionaire Philip Green ’s Arcadia fashion empire. TopShop, known for mid-priced trendy styles from talented young designers, entered the U.S. in 2009 with a store in Manhattan. Rather than pour millions into new outlets right away, Green opted for a low-risk approach by signing a deal last year with U.S. retailer Nordstrom Inc. to sell TopShop’s wares in some of its high-end department stores.

Now that shoppers from Arizona to Pennsylvania have sampled the brand, Green has plans to expand from four to 20 TopShop and TopMan outlets in the U.S. which could generate $1 billion in sales by 2018. To help fuel the rollout, Green in December sold a 25 percent stake to private-equity firm Leonard Green Partners in a deal that valued the chains at 2 billion pounds.

While TopShop plays a bit on its quirky English sensibility, other chains turn their British-ness up to 11, to borrow a phrase from “This is Spinal Tap,” the mock documentary about aging English rock stars. Two examples are Boden, an online and catalogue retailer that focuses on womenswear and kid’s clothes, and London-based Jack Wills, which targets teens and college students.

So popular are Boden’s $120 embroidered girl’s dresses among well-to-do women in New York, Dallas and San Francisco that the company says the U.S. will overtake Britain as its biggest market in the next few years. Privately held Boden has doubled capacity at its Pennsylvania warehouse and ramped up ad spending online and in fashion magazines like In Style.

More than anything else, it’s Boden’s use of British icons like red London buses that drives the appeal and challenges the big American catalogue retailers like J. Crew and LL Bean Inc.

American consumers possess an “admiration for an authentic U.K. perspective,” said Graham Hales, chief executive officer of branding consultant Interbrand, citing the popularity of Downton Abbey. “It’s a chocolate box version of the U.K. that exists in Americans’ minds.”

Boden’s U.S. revenue rose 10 percent last year to $140 million, and Granville said he expects to double that pace this year, reaching $300 million “at least” by 2017. That’s a fraction of the more than $10 billion generated in America by Gap, the biggest U.S. specialty-apparel retailer, whose sales rose 7.6 percent in the year ended Feb. 2.

Kristin Emery, a 42-year-old physiotherapist and mother of three in Virginia, started buying from Boden about five years ago. While she also shops at Gap, Nordstrom, and J. Crew, Emery spends $100 to $200 per visit at Boden, typically buying a few times each season. Her last purchase was eight pieces for her children ages 3, 7, and 9 for their spring break.

“There is an Anglophile scene there which British brands can and do tap into,” said Julian Granville, Boden’s CEO.

Jack Wills, meanwhile, has 13 outlets in the U.S. its largest overseas market. Its tagline, “Fabulously British,” mirrors that of Boden’s. The company sends brand representatives dubbed “Seasonnaires,” well-scrubbed college students, to campuses in America to host events like croquet tournaments.

While British retailers make inroads in the U.S. the best- known American retailers are looking abroad for growth. Gap will open 35 stores this year in China, a region that CEO Glenn Murphy calls “a cornerstone of future growth.” The San Francisco-based company also took its Old Navy brand outside the U.S. for the first time last year, opening an outlet in Japan, the world’s second-biggest specialty apparel market, according to data trackers Euromonitor. Gap shares have risen about 35 percent over the past year.

J. Crew’s direct business, which accounts for 30 percent of its $2.2 billion in sales, now ships to more than 100 countries, up from 29 a year ago. The closely held company plans to increase investments abroad, Chief Administrative Officer James Scully told analysts in a March 21 presentation.

Abercrombie Fitch, meanwhile, has been closing underperforming U.S. stores as it grows overseas, where sales jumped 34 percent last year. A F opened a store on London’s storied Savile Row, over the objections of the neighborhood’s bespoke tailors, who don’t fancy the chain’s nightclub vibe and shirtless employees.

As U.K. retailers cater to wider U.S. audiences, they risk losing the distinctiveness that defines them, said Marshal Cohen, chief retail analyst at The NPD Group in Port Washington, New York. One cautionary tale is Laura Ashley Holdings Plc, the London-based retailer known for its floral designs, which sold its unprofitable U.S. unit for $1 in 1999 after overexpanding just as its once sought-after designs fell out of fashion.

“Any old English brand will not necessarily do well,” said Isabel Cavill, senior retail analyst at Planet Retail in London. “It should be about caution, building out the brand and leveraging the Internet to see what is going on in the market.

By: Sarah Shannon; Editors: Celeste Perri, Matthew Boyle, Paul Jarvis


British Retailers Asos, Boden and TopShop Tap U #retail #manager #salary


#british retailers

#

British Retailers Asos, Boden and TopShop Tap U.S. Market For Growth

LONDON, United Kingdom — On the heels of Downton Abbey’s success on American television, British retailers are banking on a love of all things English to expand their business in the world’s biggest apparel market.

Leading the British invasion are online specialist Asos Plc, fashion chain TopShop, catalogue retailer Boden, youth-focused Jack Wills Ltd. and SuperGroup Plc’s Superdry stores. Their strategies vary some trade on British cool, others emphasise local knowhow yet all focus on what they do best rather than buying an existing imprint or starting an entirely new brand that Americans have never heard of.

In doing so, the retailers are learning from the mistakes of fellow British chains such as J Sainsbury Plc and Marks Spencer Group Plc who have retreated from North America. As boutique U.K. firms grab more of the $200 billion U.S. market, that poses a threat to American mainstays like Gap Inc., J. Crew Group Inc. and Abercrombie Fitch, who have been busy expanding outside their home country.

“U.K. retailers that are succeeding have a very strong, differentiated brand positioning that is well understood by the American consumer,” said Ian Geddes, U.K. head of retail at consultants Deloitte LLP. “They are doing well by emphasising what their brand stands for.”

British retailers have for decades gazed longingly across the Atlantic, and the desire to broaden their operations is stronger today amid an anemic U.K. retail industry.

Yet these forays often end badly. In 1988, Marks Spencer, Britain’s largest clothing retailer, paid $750 million for Brooks Brothers, the oldest U.S. clothier, only to sell it for less than a third of the purchase price 13 years later amid a shift away from suits to more casual duds like Gap’s khakis. Tesco Plc sunk 1 billion pounds ($1.5 billion) into its Fresh Easy U.S. grocery chain over the past five years without making a profit, and has said it will likely leave the U.S. after a review of the business.

Today, British retailers are winning fans by just being themselves. The online-only fashion retailer Asos, whose own- brand sequin sunset dress was spotted on singer Katy Perry, has lured American consumers since its 2010 debut with free delivery and returns of items ranging from $542 Edun Mesh designer jumpsuits to $11.87 own-label crop tops. It stays on top of consumer trends with an 11-strong team based in New York that makes decisions locally.

“There will be more people we put into the U.S. team so I expect them to find their footing and accelerate growth,” Finance Director Nicholas Beighton told analysts in March. “There is a bigger market in the U.S. there are more options, more channels, more digital marketing channels.”

U.S. sales increased 54 percent to 35.6 million pounds in the six months ended Feb. 28, making America Asos’s fastest- growing market. With more than one million registered customers as of December, the U.S. is now its largest market outside the U.K. with nine percent of revenue. The shares have soared 88 percent over the past year, well ahead of the FTSE All-Share Index’s 12 percent gain.

Another winner is TopShop, the flagship chain of billionaire Philip Green ’s Arcadia fashion empire. TopShop, known for mid-priced trendy styles from talented young designers, entered the U.S. in 2009 with a store in Manhattan. Rather than pour millions into new outlets right away, Green opted for a low-risk approach by signing a deal last year with U.S. retailer Nordstrom Inc. to sell TopShop’s wares in some of its high-end department stores.

Now that shoppers from Arizona to Pennsylvania have sampled the brand, Green has plans to expand from four to 20 TopShop and TopMan outlets in the U.S. which could generate $1 billion in sales by 2018. To help fuel the rollout, Green in December sold a 25 percent stake to private-equity firm Leonard Green Partners in a deal that valued the chains at 2 billion pounds.

While TopShop plays a bit on its quirky English sensibility, other chains turn their British-ness up to 11, to borrow a phrase from “This is Spinal Tap,” the mock documentary about aging English rock stars. Two examples are Boden, an online and catalogue retailer that focuses on womenswear and kid’s clothes, and London-based Jack Wills, which targets teens and college students.

So popular are Boden’s $120 embroidered girl’s dresses among well-to-do women in New York, Dallas and San Francisco that the company says the U.S. will overtake Britain as its biggest market in the next few years. Privately held Boden has doubled capacity at its Pennsylvania warehouse and ramped up ad spending online and in fashion magazines like In Style.

More than anything else, it’s Boden’s use of British icons like red London buses that drives the appeal and challenges the big American catalogue retailers like J. Crew and LL Bean Inc.

American consumers possess an “admiration for an authentic U.K. perspective,” said Graham Hales, chief executive officer of branding consultant Interbrand, citing the popularity of Downton Abbey. “It’s a chocolate box version of the U.K. that exists in Americans’ minds.”

Boden’s U.S. revenue rose 10 percent last year to $140 million, and Granville said he expects to double that pace this year, reaching $300 million “at least” by 2017. That’s a fraction of the more than $10 billion generated in America by Gap, the biggest U.S. specialty-apparel retailer, whose sales rose 7.6 percent in the year ended Feb. 2.

Kristin Emery, a 42-year-old physiotherapist and mother of three in Virginia, started buying from Boden about five years ago. While she also shops at Gap, Nordstrom, and J. Crew, Emery spends $100 to $200 per visit at Boden, typically buying a few times each season. Her last purchase was eight pieces for her children ages 3, 7, and 9 for their spring break.

“There is an Anglophile scene there which British brands can and do tap into,” said Julian Granville, Boden’s CEO.

Jack Wills, meanwhile, has 13 outlets in the U.S. its largest overseas market. Its tagline, “Fabulously British,” mirrors that of Boden’s. The company sends brand representatives dubbed “Seasonnaires,” well-scrubbed college students, to campuses in America to host events like croquet tournaments.

While British retailers make inroads in the U.S. the best- known American retailers are looking abroad for growth. Gap will open 35 stores this year in China, a region that CEO Glenn Murphy calls “a cornerstone of future growth.” The San Francisco-based company also took its Old Navy brand outside the U.S. for the first time last year, opening an outlet in Japan, the world’s second-biggest specialty apparel market, according to data trackers Euromonitor. Gap shares have risen about 35 percent over the past year.

J. Crew’s direct business, which accounts for 30 percent of its $2.2 billion in sales, now ships to more than 100 countries, up from 29 a year ago. The closely held company plans to increase investments abroad, Chief Administrative Officer James Scully told analysts in a March 21 presentation.

Abercrombie Fitch, meanwhile, has been closing underperforming U.S. stores as it grows overseas, where sales jumped 34 percent last year. A F opened a store on London’s storied Savile Row, over the objections of the neighborhood’s bespoke tailors, who don’t fancy the chain’s nightclub vibe and shirtless employees.

As U.K. retailers cater to wider U.S. audiences, they risk losing the distinctiveness that defines them, said Marshal Cohen, chief retail analyst at The NPD Group in Port Washington, New York. One cautionary tale is Laura Ashley Holdings Plc, the London-based retailer known for its floral designs, which sold its unprofitable U.S. unit for $1 in 1999 after overexpanding just as its once sought-after designs fell out of fashion.

“Any old English brand will not necessarily do well,” said Isabel Cavill, senior retail analyst at Planet Retail in London. “It should be about caution, building out the brand and leveraging the Internet to see what is going on in the market.

By: Sarah Shannon; Editors: Celeste Perri, Matthew Boyle, Paul Jarvis