title: Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis.
abstract: BACKGROUND
  Cases of acute respiratory failure reported after talc pleurodesis have raised concerns about its safety. It has been speculated that this pulmonary inflammatory syndrome is secondary to the extrapleural dissemination of the talc particles.
  
  
  OBJECTIVE
  To test the hypothesis that particle size influences extrapleural talc deposition and pleural inflammation after talc slurry pleurodesis.
  
  
  METHODS
  Thirty rabbits underwent pleurodesis as follows: 10 rabbits received 200 mg/kg of the talc used for human pleurodesis, normal talc (NT); 10 rabbits received 200 mg/kg of talc with particles of larger size, large talc (LT); and 10 rabbits received saline solution. Samples from the ipsilateral lung, chest wall, diaphragm, mediastinal pleura, heart, liver, spleen, and right kidney were obtained at 24 h and 7 days and processed for optic and electron microscopy and energy-dispersive x-ray analysis.
  
  
  RESULTS
  Visceral pleural thickening was greater with NT than with LT, but no differences were observed in the macroscopic score of adhesions. There was more talc in the lungs of the rabbits that received NT than in those that received LT. Talc particles were detected in mediastinum (100%) and pericardium (20%), irrespective of the talc used. Three animals, all receiving NT, had talc particles in the liver.
  
  
  CONCLUSIONS
  Our study shows that while both talcs were equally effective in achieving pleurodesis, the intrapleural injection of NT elicits greater pulmonary and systemic talc particle deposition than LT. Moreover, pleural inflammation was greater with NT than with LT.
authors.affiliation: Servei de Pneumologia, Hospital General Vall d'Hebron, Barcelona, Spain. jjferrer@hg.vhebron.es
authors.forename: Jaume
authors.initials: J
authors.lastname: Ferrer
authors.forename: Juan F
authors.initials: JF
authors.lastname: Montes
authors.forename: Maria A
authors.initials: MA
authors.lastname: Villarino
authors.forename: Richard W
authors.initials: RW
authors.lastname: Light
authors.forename: José
authors.initials: J
authors.lastname: García-Valero
mesh_terms: D000818:Animals; D005549:Foreign-Body Reaction / Q000473:pathology; D008297:Male; D008855:Microscopy, Electron, Scanning; D010316:Particle Size; D010994:Pleura / Q000473:pathology; D018700:Pleurodesis / Q000379:methods*; D011817:Rabbits; D012965:Sodium Chloride; D013627:Talc / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity; D014018:Tissue Distribution
chemical_list: D013627:Talc; D012965:Sodium Chloride