ABSTRACT
RATIONALE: Talc is very effective for pleurodesis, but there is concern about complications, especially acute respiratory distress syndrome. OBJECTIVES: It was the aim of this study to investigate if talc with a high concentration of small particles induces greater production of cytokines, and if pleural tumor burden has any influence on the local production and spillover of cytokines to the systemic circulation and eventual complications. METHODS: We investigated 227 consecutive patients with malignant effusion submitted to talc pleurodesis. One hundred and three patients received 'small-particle talc' (ST; containing about 50% particles <10 µm) and 124 received 'large-particle talc' (with <20% particles <10 µm). Serial samples of both pleural fluid and blood were taken before and 3, 24, 48 and 72 h after thoracoscopy. Also, mesothelial cells were stimulated with both types of talc in vitro. MEASUREMENTS AND RESULTS: Interleukin-8, tumor necrosis factor-α, vascular endothelial growth factor, basic fibroblast growth factor and thrombin-antithrombin complex were measured in all samples. Early death (<7 days after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the 'large-particle talc' group (p = 0.007). Patients who received ST had significantly higher proinflammatory cytokines in pleural fluid and serum after talc application, and also in supernatants of the in vitro study. Pleural tumor burden correlated positively with proinflammatory cytokines in serum, suggesting that advanced tumor states induce stronger systemic reactions after talc application. CONCLUSIONS: ST provokes a strong inflammatory reaction in both pleural space and serum, which is associated with a higher rate of early deaths observed in patients receiving it.
Subject(s)
Lung Diseases/chemically induced , Pleural Effusion, Malignant/therapy , Pleurodesis/adverse effects , Talc/adverse effects , Biomarkers/blood , Blood Coagulation Factors/metabolism , Cells, Cultured , Cytokines/blood , Female , Humans , Intercellular Signaling Peptides and Proteins/blood , Lung Diseases/epidemiology , Lung Diseases/pathology , Male , Middle Aged , Particle Size , Pleural Effusion, Malignant/epidemiology , Pleural Effusion, Malignant/pathology , Pleural Neoplasms/pathology , Pleurodesis/mortality , Retrospective Studies , Spain/epidemiology , Talc/chemistry , Thoracoscopy , Tumor BurdenABSTRACT
The article read over the intellectual connection between two physiologists, the Catalan exiled Augusto Pi Suñer in 1939 and the Venezuelan Francisco De Venanzi beyond their common research subject like as: the academic insertion of the biological sciences and the related debate with the natural sciences; the scientific development and the necessity to attract the human resources for it; the publication of the project results by owner institutional reviews; the legal establishment at the highest govern level to development the scientific research. All of these subjects were developed when the scientific community in Venezuela are confirming her institutional organization.
