Changes in the Pleural Cavity by Pleurodesis Using Talc or OK-432: An Experimental Study

ArticleinSurgery Today 41(1):111-4 · January 2011with9 Reads
DOI: 10.1007/s00595-010-4275-3 · Source: PubMed
To define the changes in the pleural cavity after pleurodesis induced by talc or OK-432. A total of 30 rats were divided into three groups: a normal saline group (control group, n = 10), a group administered 400 mg/kg talc (talc group, n = 10), and a group administered 0.3 KE/kg OK-432 (OK-432 group, n = 10). Pleural cavities were examined and scored on the 30th day after the intrapleural administration of each agent. Both the talc group and OK-432 group showed significantly higher macroscopic or microscopic pleurodesis scores than the control group (P < 0.05). Upon microscopic evaluation, the pleurodesis scores in the talc group were significantly higher than those in the OK-432 group (P < 0.01).The majority of the pleural thickness was found on the visceral pleura, and the parietal pleura was very thin. The thickness of the visceral pleura in the talc group was significantly higher than that in the OK-432 group (P < 0.005). Pathologically, the pleural thickening in the talc group consisted of fibrous tissue with injury of the pleural mesothelium, and talc particles were seen in the submesothelial fibrotic tissue and inside the alveoli. Talc pleurodesis induces more marked changes in the pleural cavity than OK-432-induced pleurodesis.
    • "We selected the lowest quantity of ME that produced recognizable changes in the pleural cavity. We determined the optimum quantity of talc for pleurodesis according to Muta's report [8]. "
    [Show abstract] [Hide abstract] ABSTRACT: Chemical pleurodesis is an effective treatment modality to reduce recurrence of malignant effusion. Several agents have been used in chemical pleurodesis but, it is not yet clear which is better. Eighteen Sprague-Dawley rats were used and classified into three groups: a group intrapleurally injected normal saline (group A, n=6), 400mg/kg talc (group B, n=6), and 9mg/kg mistletoe extraction (ME) (group C, n=6). Autopsy was performed to evaluate the pleural adhesion, pathologic examination of pleura and lung and bronchoalveolar lavage fluid analysis 4 weeks after pleurodesis. Both group B and C showed an obvious pleural adhesion and there was no significant difference in grade of pleural adhesion between two groups (p=0.58). The parietal pleural thickness in talc group than ME group was significantly thicker (p=0.002) and the visceral pleura of talc group showed marked foreign body reaction with fibrosis and many multinucleated giant cells associated with talc crystal. This study suggests that pleurodesis using ME in condition without malignancy has comparable effect to pleurodesis using talc. However, additional experimental study in large animal or clinical trials would be required to prove a safety and an efficacy of pleurodesis using ME.
    Full-text · Article · Aug 2015
  • [Show abstract] [Hide abstract] ABSTRACT: At times when patients have a malignant pleural effusion or a pneumothorax, one wishes to eliminate the pleural space by pleurodesis. This article describes results from attempting pleurodesis with silver nitrate, iodopovidone (betadine), transforming growth factor beta (TGFβ), OK432, and lipoteichoic acid-T. The two most promising agents seem to be silver nitrate and iodopovidone. Both agents induce pleurodesis that is at least comparable with that produced by talc, and neither induced the acute respiratory distress syndrome that sometimes occurs after intrapleural administration of talc.
    Article · Jun 2013
  • [Show abstract] [Hide abstract] ABSTRACT: IntroductionIn patients with refractory pleural effusion or pneumothorax, fever and elevated level of white blood cell count (WBC) are frequently observed after chemical pleurodesis with intrapleural injection of OK-432, which make it difficult to differentiate whether it was from the side effects of OK-432 or concurrent bacterial infection. Objective Procalcitonin (PCT) levels were measured before and after pleurodesis so as to discuss whether PCT is useful for distinguishing between the side effects of OK-432 and concurrent bacterial infection. Method Twenty-six patients with refractory pleural effusion or pneumothorax who underwent chemical pleurodesis with intrapleural injection of OK-432 at the First Affiliated Hospital of Sun Yat-sen University between August 2010 and August 2012 were included in our study. Levels of PCT and WBC were measured before and after pleurodesis. ResultOf all 26 patients, 22 patients were with refractory pleural effusion, and the other four were with pneumothorax. The median serum levels of PCT and WBC elevated from 0.155 to 1.470ng/mL (P=0.009) and from 5.920 to 10.475x10(9)/L (P=0.000), respectively. No patient was given antibiotics and fever subsided. Conclusion Intrapleural injection of OK-432 could increase the serum level of PCT and WBC with no bacterial infection. The serum PCT level may not be useful to distinguish whether fever was caused by the side effects of OK-432 or concurrent bacterial infection.
    Article · May 2013
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