Thoracoscopy Talc Poudrage

Campos, José Ribas Milanez de; Cardoso, Paulo Francisco Guerreiro; Vargas, Francisco S.; Werebe, Eduardo de Campos; Teixeira, Lisete R.; Jatene, Fábio Biscegli; Light, Richard W.

doi:10.1378/chest.119.3.801

Cited by 272 publications

(141 citation statements)

References 25 publications

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“…Lung manifestations from pleural instillation are not common, though cases of acute respiratory failure from systemic absorption of intrapleural talc have been reported. 7,8 Talc particles in crushed oral medications that are injected intravenously become entrapped in the pulmonary vasculature and can then move into the interstitium and cause a granulomatous reaction. These granulomas have giant cells that can be visualized as birefringent talc crystals with polarized light.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Talcosis With Intravenous Drug Abuse

2013

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Section: Discussionmentioning

confidence: 99%

Pulmonary Talcosis With Intravenous Drug Abuse

2013

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“…Therefore, several methods have been attempted for the symphysis of pleura after excising blebs in order to reduce the rate of recurrence. Several methods of pleurodesis, including pleurectomy [8,9], pleural abrasion [10][11][12], and chemical pleurodesis [13,14], have been performed. As shown in Table 4, each procedure yielded good results in preventing the postoperative recurrence.…”

Section: Discussionmentioning

confidence: 99%

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

et al. 2008

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Background Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. Materials and methods Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy with staple line covering with absorbable cellulose mesh and fibrin glue followed by an additional mechanical pleurodesis. These patients were compared with 98 patients who underwent thoracoscopic bullectomy with staple line coverage alone. Results The additional mechanical pleurodesis group had findings comparable to those of the coverage group for duration of postoperative chest drainage, length of hospital stay, and complication rate. After median follow-up of 29.2 months, postoperative recurrence occurred in four patients (4.0%). Conclusions Additional mechanical pleurodesis after covering procedure is also effective in decreasing postoperative recurrence of PSP.Keywords Primary spontaneous pneumothorax (PSP) Á Mechanical pleurodesis Á Video-assisted thoracic surgery (VATS) Primary spontaneous pneumothorax (PSP) is well known to have high recurrence rates if not treated appropriately. There are ongoing debates on how to most effectively lower its recurrence after the first clinical treatment. Conservative treatments, such as needle aspiration or pleural drainage with a chest tube, show rather high recurrence rates, varying from 11% up to 36% [1]. Active surgical operations using thoracoscopy have resulted in a significant reduction in overall morbidity. However, wedge resection alone by video-assisted thoracoscopic surgery (VATS) has caused some doubts due to the high recurrence rates, hence various pleural symphyses have been performed in order to reduce its recurrence rate. In a previous retrospective study, Sakamoto et al. found that a staple line coverage procedure, which helps reduce the recurrence rate by minimizing the formation of new blebs near the staple line, showed a recurrence rate comparable to that of pleural symphysis, and as a result it has been confirmed that this procedure is effective in decreasing the recurrence rate of PSP [2,3].In this context, some questions have been raised as to whether additional mechanical pleurodesis can further reduce the recurrence rate if performed simultaneously

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“…Drainage of the pleural cavity and instillation of a sclerosing agent is the standard method to produce pleural symphysis and prevent fluid re-accumulation [2][3][4]. Talc, instilled either by slurry or by thoracoscopy [5][6][7], has been shown to produce more than 90% success in the control of recurrent malignant pleural effusion [8,9]. The mechanism by which talc produces a pleurodesis remains unclear.…”

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confidence: 99%

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

Marchi

Vargas²,

Acencio³

et al. 2006

European Respiratory Journal

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Intrapleural instillation of talc is used to produce pleurodesis in cases of recurrent malignant pleural effusions. The mechanisms by which pleurodesis is produced remain unknown but may involve either injury or activation of the mesothelium. The aim of the current study was to assess the inflammatory response of pleural mesothelial cells to talc in an experimental model in rabbits.A group of 10 rabbits were injected intrapleurally with talc (200 mg?kg -1 ) and undiluted pleural fluid was collected after 6, 24 or 48 h for measurement of interleukin (IL)-8, vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-b1. Samples of pleura were studied to assess the inflammatory infiltrate and mesothelial cell viability.The pleural fluid IL-8 concentration peaked at 6 h, whereas VEGF and TGF-b1 concentrations increased steadily over 48 h. Immunohistochemistry for cytokeratin showed a preserved layer of mesothelial cells despite the intense inflammatory pleural reaction.In conclusion, it is proposed that the mesothelial cell, although injured by the talc, may actively mediate the primary inflammatory pleural response in talc-induced pleurodesis.

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Thoracoscopy Talc Poudrage

Cited by 272 publications

References 25 publications

Pulmonary Talcosis With Intravenous Drug Abuse

Pulmonary Talcosis With Intravenous Drug Abuse

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

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