ABSTRACT
PURPOSE: To evaluate macro and microscopically, changes following the use of the aqueous extract of babassu (Orbignya phalerata) in the lung parenchyma and pleura of rats. METHODS: Sixty adult male rats with average weight of 350 g, were randomized into two groups of 30 animals (experimental and control) further divided into sub-groups of 10 to be sacrificed at 48 h, 72 h and 21 days. The substance was injected into the right pleura of the animals. RESULTS: There was intense pleuropulmonary macroscopic reaction with statistically significant differences between groups respectively (p<0.05, p<0.02, p<0.03). Microscopically, no statistically significant difference was evident (p>0.05). CONCLUSION: The aqueous extract of babassu (Orbignya phalerata) was found to be highly irritating to the pleura and lung of rats, evidenced macroscopically by numerous adhesions and inflammation while no major changes were evident microscopically.
Subject(s)
Animals , Male , Rats , Pleura/drug effects , Plant Extracts/pharmacology , Pleurodesis/methods , Arecaceae/chemistry , Lung/drug effects , Pleura/pathology , Pneumonia/chemically induced , Time Factors , Wound Healing , Random Allocation , Reproducibility of Results , Disease Models, Animal , Lung/pathology , Anti-Inflammatory Agents/pharmacologyABSTRACT
OBJECTIVES: Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model. METHODS: New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed. RESULTS: An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits. CONCLUSION: Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated. .
Subject(s)
Animals , Rabbits , Pleural Effusion, Malignant/therapy , Pleurodesis/methods , Povidone-Iodine/administration & dosage , Sclerosing Solutions/administration & dosage , Cytokines/blood , Enzyme-Linked Immunosorbent Assay , Models, Animal , Pleura/drug effects , Povidone-Iodine/adverse effects , Retinal Pigment Epithelium/drug effects , Sclerosing Solutions/adverse effects , Time FactorsABSTRACT
PURPOSE: Chemical pleurodesis is a therapeutic tool for the treatment of recurrent pleural effusions, mainly those of neoplastic etiology. In the past, tetracycline was the sclerosant agent of choice in clinical practice, but presently, there is no consensus about an ideal agent. The aim of this study was to evaluate the effectiveness of macrolides (azithromycin and clarithromycin) or quinolones (levofloxacin and gatifloxacin) in inducing experimental pleurodesis in rabbits. METHOD: Forty New Zealand rabbits randomized into groups of 10 received (at a total volume of 2 mL for each animal) 1 of the 4 drugs by intrapleural injection. After 28 days, the animals were euthanized and the pleural cavity was evaluated macroscopically and microscopically. RESULTS: The intensity of the macroscopic adhesions was mild in all groups. On microscopic analysis, minimal pleural fibrosis and inflammation were observed in all animals. CONCLUSION: The macrolides (azithromycin or clarithromycin) and the quinolones (levofloxacin or gatifloxacin) when injected into the normal pleural space of rabbits are not effective in promoting pleurodesis. Additional research is required to identify sclerosing agents capable of inducing pleurodesis.
OBJETIVO: A pleurodese química representa uma ferramenta terapêutica utilizada no tratamento dos processos pleurais recidivantes, principalmente nos derrames neoplásicos. A escolha do melhor esclerosante pleural é ainda motivo de controvérsia, não havendo consenso com relação ao agente considerado ideal. O objetivo deste estudo é avaliar a efetividade dos macrolídeos (azitromicina e claritromicina) e das quinolonas (levofloxacina e gatifloxacina) na indução de pleurodese experimental em coelhos. MÉTODOS: Quarenta animais randomizados em grupos de 10, receberam, em volume total de 2 mL, estas drogas através de injeção intrapleural. RESULTADOS: Após 28 dias, os animais foram sacrificados sendo avaliada a cavidade pleural. A intensidade das aderências macroscópicas assim como da fibrose e da inflamação observadas à microscopia foi discreta tanto no grupo que recebeu macrolídeos quanto naquele que recebeu quinolonas. CONCLUSÃO: Azitromicina, Claritromicina, Levofloxacina e Gatifloxacina quando injetados na cavidade pleural de coelhos, não são eficazes na indução de pleurodese. Novas pesquisas devem ser realizadas com o intuito de identificar agentes esclerosantes capazes de produzir sínfise pleural.
Subject(s)
Animals , Rabbits , Macrolides/administration & dosage , Pleura/pathology , Pleural Diseases/drug therapy , Pleurodesis/methods , Quinolones/administration & dosage , Sclerosing Solutions/administration & dosage , Analysis of Variance , Disease Models, Animal , Fibrosis , Pleura/drug effects , Pleural Cavity/drug effects , Pleural Cavity/pathology , Pleural Diseases/pathology , Pleurodesis/standards , Random AllocationABSTRACT
Introducción: la instilación de anestésicos locales en el espacio pleural se ha usado para mejorar el dolor de las fracturas costales. Objetivo: determinar la eficacia y seguridad de la analgesia interpleural en pacientes con trauma torácico en una UCI. Pacientes y métodos: se hizo un estudio prospectivo y aleatorio de analgesia interpleural en nueve pacientes con trauma torácico. Instilamos solución de bupivacaína al 5 por ciento o placebo (grupo A, grupo B, respectivamente) dentro del espacio pleural a través de un catéter insertado específicamente para este propósito. El nivel de analgesia se evaluó mediante la escala visual análoga (EVA). Resultados: después de la instilación de las soluciones, EVA fue de 4.4/10 en el grupo A y 7.5/10 en el grupo B, y el uso de analgésicos fue 1.2 y 5.2 dosis, respectivamente. Conclusión: proponemos el uso de analgesia interpleural en pacientes de la UCI con trauma torácio severo como primera elección
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anesthesia, Local , Anesthesia, Local/instrumentation , Bupivacaine/administration & dosage , Bupivacaine/pharmacokinetics , Pain Measurement , Pleura/drug effects , Thoracic InjuriesABSTRACT
The identity of the histamine-potentiating activity detected in the rat anaphylactic pleural washing was investigated. Wistar rats of both sexes, weighing 150-200 g, were sensitized by injecting subcutaneously (sc) a mixture of ovalbumin and Al(OH)3 14 days before allergen challenge. In sensitized rats, intrapleural (ipl) injection of ovalbumin (l2 mug/cavity) caused an intense protein exudation. A single ipl administration of compound 48/80 (l2 mug/cavity) exhausted the resident mast cell population and turned the pleural cavity hyporeactive to the allergen challenge performed 5 days later. Allergen-induced exudation occurred in parallel to a dramatic decrease in the amount of cell-stored histamine (from 9.6 ñ 1.4 (N = 8) to 1.3 ñ 0.1 (N = 6) mug/cavity, P<0.001) in the pleural fluid within 10 min. The anaphylactic cell-free pleural washing obtained at this time, as well as histamine at a concentration equivalent to that stored in pleural mast cells (10 mug/cavity), did not induce pleural exudation when injected into normal rats. In contrast the combined administration of histamine and anaphylactic pleural washing led to remarkable pleural exudation, comparable to that obtained with a high dose of histamine (200 mug/cavity) alone. It is noteworthy that the anaphylactic washing from compound 48/80 pretreated rats failed to synergize with histamine. Also, synergism was not reproduced when recipient rats were pretreated with methysergide (50 mug/cavity). Consistently, serotonin (5 mug/cavity) acted synergistically with histamine (1O mug/cavity), producing a greater exudative response than observed with the sum of the effects of each vasoactive amine alone. The results indicate that serotonin accounts for the histamine-potentiating activity noted in the anaphylactic pleural washing, confirming that the synergistic interaction between these vasoactive amines plays a critical role in the rat allergic pleurisy.
Subject(s)
Rats , Animals , Female , Anaphylaxis/pathology , Histamine/pharmacology , Pleura/drug effects , Serotonin/pharmacology , Pleural Effusion/pathology , Pleurisy , Rats, WistarABSTRACT
El derrame pleural neoplásico es una manifestación de enfermedad avanzada y su tratamiento debe dirigirse a mejorar la calidad de vida con baja morbilidad. Se expone la conducta seguida utilizando un flujograma terapéutico para la indicación del sellamiento pleural con tetraciclinas o pleurectomia. Se trataron 32 pacientes con derrame y sintomatología invalidante, en 29 se realizó pleurodesis con tetraciclina con un 97// de respuestas. La hipertemia (28//) y el dolor (24//) fueron complicaciones más frecuentes. En los 3 restantes se efectuó pleurectomía y no recidivó el derrame, pero dos se complicaron (infección de herida y defecto de reexpansión). La supervivencia media fue de 9,2 meses
Subject(s)
Humans , Female , Adult , Middle Aged , Pleural Effusion, Malignant/therapy , Neoplasms/complications , Pleural Effusion/etiology , Clinical Protocols/standards , Tetracycline/therapeutic use , Algorithms , Biopsy, Needle , Biopsy, Needle/adverse effects , Biopsy, Needle/standards , Drainage/adverse effects , Drainage/standards , Pleural Effusion, Malignant/surgery , Pleural Effusion, Malignant/diagnosis , Tissue Expansion/statistics & numerical data , Sodium Hydroxide/therapeutic use , Pneumonolysis/adverse effects , Pneumonolysis/methods , Pleura/drug effects , Pleura/surgery , Quinacrine/therapeutic use , Tetracyclines/therapeutic useABSTRACT
Se han recomendado diferentes fármacos y procedimientos para impedir la formación y acumulación de líquido en la cavidad pleural, entre los fármacos citotóxicos más utilizados se encuentran: metotrexate, ciclofosfamida, mostaza nitrogenada, etc. Siendo el talco y la tetraciclina las sustancias más comúnmente utilizadas para inducir pleurodesis e impedir la acumulación del líquido plural. En nuestra institución en 1989, se efectuó un estudio de investigación en ratas, a las que se les administró yodopovidona a la cavidad plerural. El resultado de la aplicación de este producto en este estudio experimental produjo reacción inflamatoria, fibrosis y asherencia pleural, en base a éstos hallazgos, fundamentamos su utilización en pacientes con derrame plerural neoplásico masivo y/o recidivante. Se evaluaron 36 pacientes (19 mujeres, 17 hombres, entre los 33 y 88 años) con diagnóstico de derrame pleural neoplásico, tratados mediante pleurodesis con yodopovidona al 20 por ciento más 200 mg de lidocaína al 2 por ciento, en 31 de ellos se obtuvo eficacia del procedimiento en la primera aplicación y en dos más en una segunda aolicación (total 33 pacientes, 91.6 por ciento). Unicamente en tres pacientes (8.4 por ciento) no se obtuvieron los resultados deseados. En ningún caso se observó algún tipo de complicación y ningún paciente reportó dolor y otro tipo de molestias. El presente estudio, nos permite concluir que la yodopovidona es eficaz en el tratamiento del derrame pleural neoplásico masivo o recidivante
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pleural Effusion/drug therapy , Povidone-Iodine/therapeutic use , Pleura/drug effects , Povidone-Iodine/administration & dosageABSTRACT
Se plantea el uso de la técnica de analgesia interpleural por catéter con la administración de bupivacaína al 0.5 por ciento con adrenalina para el control del dolor postoperatorio en pacientes sometidos a cirugía de tórax unilateral (toracotomía). Se estudiaron 20 pacientes a los cuales al término de la cirugía se les colocó un catéter interpleural a nivel del segundo espacio intercostal ipsilateral por el cual se administró 100 mg de bupivacaína al 0.5 por ciento con adrenalina cada vez que el paciente presentó dolor y éste fue mayor de 5 en la escala visual análoga. El control del dolor se realizó por 72 horas a cada paciente. La analgesia fue adecuada en 18 (n=20) pacientes (p<0.005) sin encontrar alteraciones en la frecuencia cardiaca-respiratoria ni en la tensión arterial. Se considera que éste es un método útil, y seguro.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pain, Postoperative/drug therapy , Pleura/drug effects , Thoracotomy , Anesthesia , Bupivacaine/therapeutic useABSTRACT
Frente a la situación de derrame pleural maligno recidivante se plantea como una solución práctica la producción de sínfisis pleural. Se realizó un estudio controlado prospectivo y comparativo para lo que se diseñó un modelo para testar dos sustancias alcalinas utilizando hidróxido de sodio y terramicina con un grupo testigo (agua destilada) y a su vez comparándolas entre sí. Las mismas fueron inyectadas en el espacio pleural derecho de la rata. Se concluye que el hidróxido de sodio al 2// es efectivo en producir sífisis pleural completa y que la terramicina produce engrosamiento pleural y adherencias laxas en forma de placas pleurales aisladas