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GAO, Zhan-cheng; XUE, Pei-li; ZHANG, Yang; SHEN, Dan-hua; WANG, Jun; HE, Quan-ying

Section Editor(s): QIAN, Shou-chu; HAO, Xiu-yuan

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Edited by QIAN Shou-chu and HAO Xiu-yuan

Departments of Respiratory and Critical Care Medicine, People’s Hospital, Peking University, Beijing 100044, China

Email: gaozhancheng@163.com

(Received May 12, 2006)

To the Editor: We are pleased to respond to the letter of Zarogiannis and his colleagues1 for their interest in our study,2 emphasizing the role of human visceral pleura in pleura fluid turnover. We definitely agree to Zarogiannis and colleagues’ comments that the absence of many cuboidal cells in the visceral pleura does not favor the existence of visceral lymphatic stomata. However, any medical basic theory must be tested clinically, or used to interpret clinical phenomena well. The current model of pleural fluid turnover3,4 is hard to explain more frequently those with pleural effusion found in patients with merely left heart failure than those with merely right heart failure.2,5 Especially, many lymphatic vessels are located not only in the subpleural connective tissue, but just in the visceral submesothilium as well in human pulmonary lymphangiopathologic models, such as pulmonary lymphangitic carcinomatosis and lymphangioleio- myomatosis.2 These phenomena suggest that the pulmonary lymphatic vessels originate from the visceral pleura. However, this hypothesis is just conjectured from clinical and pathological presentations, which need to be identified morphologically with the typical orifice of a lymphatic stoma on the visceral pleura under the scanning electron microscopy as Zarogiannis and colleagues proposed. We will continue this project and hopefully collaborate with the international laboratory for further investigation.

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REFERENCES

1. Zarogiannis S, Hatzoglou C, Gourgoulianis K, Molyvdas PA. Role of human visceral pleura in pleural fluid turnover: Need for morphological evidence of lymphatic stomata. Chin Med J 2006; 119:1495-1496.
2. Gao ZC, Xue PL, Zhang Y, Shen DH, Wang J, He QY. Potential role of human visceral pleura in pleura fluid turnover. Chin Med J 2006; 119:250-254.
3. Miserocchi G, Venturoli D, Negrini D, Del Fabbro M. Model of pleural fluid turnover. J Appl Physiol 1993; 75:1798-1806.
4. Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J 1997;10:219-225.
5. Wiener-Kronish JP, Goldstein R, Matthay RA, Biondi JW, Broaddus VC, Chatterjee K, et al. Lack of association of pleural effusion with chronic pulmonary arterial and right atrial hypertension. Chest 1987; 92: 967-970.
© 2006 Chinese Medical Association