Talc Slurry Pleurodesis: Pleural Fluid and Histologic Analysis

doi:10.1378/chest.107.6.1707

Chest

Volume 107, Issue 6, June 1995, Pages 1707-1712

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Although talc slurry pleurodesis is effective for control of malignant pleural effusions and recurrent pneumothorax, the mechanisms of pleurodesis remain incompletely defined. We instilled 70 mg/kg of sterile asbestos-free talc slurry into the pleural space of New Zealand white rabbits and studied the inflammatory response at 1, 2, 3, 7, 15, 30, 60, 90, and 120 days by observing pleural fluid and histologic characteristics. Talc slurry caused mesothelial denudement and an exudative neutrophilic pleural effusion that resolved after 48 h. A transient mononuclear vasculitis was seen within the lung at 1, 2, and 3 days after instillation. Pleural adhesions were minimal and did not increase in number over time. Talc was found outside of the pleural space in mediastinal lymph nodes (4 of 23 animals examined), kidney (1 of 6), and spleen (4 of 10). The predominant cause of pleurodesis with talc slurry instillation is an acute pleural injury similar to the tetracycline class agents.

Section snippets

Methods

Twenty-eight New Zealand white rabbits weighing 2 to 3 kg were lightly anesthetized with 80 to 100 mg of ketamine hydrochloride (Ketalar, Parke-Davis, Morris Plains, NJ) and 0.25 mg/kg acepromazine (PromAce, Aveco, Fort Dodge, Iowa) via the lateral ear vein. The right chest wall was shaved and a 1.0-cm skin incision was made midway between the spine and scapular tip. With aseptic technique, an 18-gauge plastic catheter (Cathlon IV Striped, Critikon, Tampa, Fla) was placed percutaneously into

Pleural Fluid

Animals had a small volume of pleural fluid at 24 and 48 h following talc slurry administration (2.9 mL and 1.7 mL, respectively). There was less than 0.2 mL pleural fluid in all animals at other time points. The 24-h nucleated cell response was modest (3,300 cells per microliter) and declined on the second day. Neutrophils were the predominant cell at 24 h (56%) while monocytes and macrophages were predominant by 48 h. Pleural fluid pH ranged from 7.38 to 7.48. Pleural fluid was exudative with

Discussion

Talc as a slurry, as opposed to talc insufflation, has been criticized as a method of administration for pleurodesis because of nonuniform distribution in the pleural space. We considered that a better understanding of the mechanisms of talc pleurodesis would be helpful in resolving the issue of route of administration. Therefore, we analyzed pleural fluid and gross and histologic pathologic findings in an animal model to better characterize the mechanisms of pleural symphysis.

Early work by

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Application of subcutaneous talc after axillary dissection in a porcine model safely reduces drain duration and prevents seromas
2012, Journal of the American College of Surgeons
Citation Excerpt :
Three animal studies have examined systemic distribution of talc after pleurodesis. Kennedy and colleagues53 demonstrated distribution of talc to multiple lymph nodes as well as spleen, lung, and kidney, with associated localized inflammatory reactions. Werebe and associates43 also used a small particle talc and found talc particles in 100% of organs in all rats harvested at 24 and 48 hours.
Talc, the most common pleurodesis agent, has recently been shown to prevent seromas and decrease drain duration when placed subcutaneously after large subcutaneous dissection accompanying open ventral hernia repair. We hypothesized that talc would decrease drain duration and prevent seromas after axillary dissection without local or systemic side effects.
Six pigs underwent full, bilateral axillary dissection (n 12 dissections). Three animals each had aerosolized small particle (SP) talc and large particle (LP) talc sprayed unilaterally (TALC) before closure, with the contralateral axillary dissection serving as the control (NOTALC). Functional status, wound complications, and drain duration were recorded. Local neurovascular structures and systemic organs were harvested at 28 days, processed with hematoxylin and eosin, and examined under normal and polarized light microscopy by blinded physicians.
All pigs were back to baseline functional status by 72 hours. Two seromas (33%) were noted in the NOTALC dissections vs 0 in the TALC group (0%). Drain duration was significantly decreased in TALC vs NOTALC dissections (8.3 ± 2.7 vs 12.0 ± 3.2 days, p = 0.03), as was total drain volume (222.5 ± 127.1 mL vs 334.2 ± 137.9 mL, p = 0.02). Gross and histologic evaluation revealed neurovascular structures to be intact. Minimal splenic deposition of talc within macrophages without evidence of injury was identified in all specimens, with fewer deposits in the large particle talc group. Serum laboratory examination at time of harvest revealed all animals to have normal values.
Direct application of talc throughout the wound after axillary dissection in pigs decreased drain duration and drain volume and prevented seroma formation. Gross, histologic, and serum laboratory evaluation demonstrated no talc-related local or systemic complications. Aerosolized talc is an effective and safe pretreatment to prevent seromas and hasten drain removal after axillary dissection.
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Laboratory and Animal InvestigationsTalc Slurry Pleurodesis: Pleural Fluid and Histologic Analysis

Section snippets

Methods

Pleural Fluid

Discussion

Chest

J Thorac Surg

J Thorac Surg

J Thorac Surg

J Thorac Cardiovasc Surg

Chest

Chest

Exp Mol Pathol

Chest

J Thorac Cardiovasc Surg

Hum Pathol

Ophthalmology

The effect of common sclerosing agents on the rabbit pleural space

Am Rev Respir Dis

Laboratory and Animal Investigations
Talc Slurry Pleurodesis: Pleural Fluid and Histologic Analysis