ABSTRACT
O linfoma primário de cavidade é um tipo raro de linfoma não-Hodgkin que acomete principalmente pacientes imunocomprometidos e, mais raramente, pacientes imunocompetentes. Neste relato de caso são apresentados os achados clínicos e laboratoriais de um paciente imunocompetente com derrame pleural diagnosticado como linfoma primário de cavidade pleural.
Primary effusion lymphoma is an unusual non-Hodgkin's lymphoma rarely seen in immunocompetent patients. Herein, we present clinical and biochemical data obtained from an immunocompetent patient diagnosed with primary effusion lymphoma.
ABSTRACT
OBJECTIVE: To evaluate the pleuropulmonary alterations caused by intrapleural injection of silver nitrate or talc in an experimental model, in order to consider its use in human beings. METHOD: 112 rabbits were randomly selected to receive intrapleural 0.5 percent silver nitrate or 400 mg/kg talc slurry in 2 ml saline. Eight rabbits of each group were sacrificed after 1, 2, 4, 6, 8, 10, or 12 months. Regarding the pleural cavity, the degree of macroscopic pleurodesis (adherences) and microscopic alterations, represented by inflammation and pleural fibrosis, were analyzed. The parenchyma was evaluated regarding the degree of alveolar collapse, intra-alveolar septum edema, and cellularity, on a 0 to 4 scale. RESULTS: Intrapleural injection of silver nitrate produced earlier and more intense pleurodesis than talc slurry injection. The parenchymal damage was more evident with silver nitrate, considered as moderate, and limited to the first evaluation (after one month). From the second month on and throughout the entire one-year follow-up, the parenchymal damage was similar with both substances, only the pleural adherences were more intense with silver nitrate. CONCLUSIONS: Intrapleural silver nitrate produces better and longer-lasting than intrapleural talc injection. The parenchymal alterations, although discreet, are more pronounced when silver nitrate is used, but minimal after two months, and similar to those produced by talc injection during the entire one-year observation period. These effects on the pulmonary parenchyma do not contraindicate the use in humans. Thus, the use of intrapleural silver nitrate to produce fast and effective pleurodesis can be considered in patients in which pleural cavity symphysis is desired.
Subject(s)
Animals , Rabbits , Pleura , Pleurodesis , Lung , Lung/pathology , Silver Nitrate , TalcABSTRACT
The ideal agent for producing pleurodesis has not been identified. Talc, the most commonly used, poses several problems. Another possibility is silver nitrate, which was widely used in the past. PURPOSE: To determine the influence of the intrapleural instillation of lidocaine in producing a pleurodesis with silver nitrate, to define the effect of lidocaine in the maturation of the collagen fibers, and to confirm that the pleurodesis after silver nitrate is stronger than after talc. METHODS: We studied three groups of 8 rabbits. Two groups received 0.5 percent silver nitrate; in one we had previously injected 0.5 ml of 2 percent lidocaine. The third group received 400 mg/kg talc (2 ml). The animals were sacrificed 28 days after the injection, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of inflammation and fibrosis. The total amount of pleural collagen and the distribution of thick and thin collagen fibers were quantified. Collagen was identified using picrosirius red stain. RESULTS: In the two groups that received silver nitrate (without lidocaine: 3.5 + 03 and with lidocaine: 3.2 + 0.3), the macroscopic pleurodesis (scale 0 3/4 4) was significantly (p = 0.001) better than that resulting from talc (1.6 + 0.2). The mean degree of pleural fibrosis induced by silver nitrate (3.5 + 0.2) was significantly (p = 0.004) higher than that induced by talc (1.9 + 0.1). The previous instillation of lidocaine resulted in a tendency for decreased amounts of fibrosis (3.1 + 0.4). The mean amount (10(3)mm2) of pleural collagen was significantly (p = 0.009) greater in the rabbits that received silver nitrate (116.9 + 22.7) than in those that received talc (10.7 + 3.4). The injection of lidocaine slightly reduced the collagen (80.1 + 30.3). The distribution of collagen fibers did not differ among the groups. CONCLUSION: This rabbit model clearly confirms that intrapleural silver nitrate is more effective than talc for producing pleurodesis. The previous intrapleural instillation of lidocaine results in a decreasing trend in the amount of collagen, but does not change the effectiveness of the pleural fusion or modify the process of collagen maturation.